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					      PROPOSED
      FY 2012
    MISSISSIPPI
STATE HEALTH PLAN


  Mississippi State Department of Health
.
PROPSED FY 2012
    MISSISSIPPI
STATE HEALTH PLAN




  Mississippi State Department of Health
.
Governor’s Letter of Approval

      (To be Included)
             Governor
        State of Mississippi
   The Honorable Haley Barbour



Mississippi State Board of Health
Lucius M. Lampton, MD, FAAFP, Chairman

 David C. Williams, MD, Vice-Chairman

        Elayne H. Anthony, PhD

       Albert Randel Hendrix, PhD

       Carl L. Nicholson, Jr., CPA

         Sammie Ruth Rea, RN

        Ronald W. Robertson, Sr.

           Thad Waites, MD

           Ellen Williams, RN



       State Health Officer
        Mary Currier, MD, MPH
.
                                      Acknowledgments
The Mississippi Department of Health, Division of Health Planning and Resource Development,
prepared the FY 2011 Mississippi State Health Plan(also State Health Plan, or Plan) in accordance
with Sections 41-7-173(s) and 41-7-185(g) Mississippi Code 1972 Annotated, as amended.

The FY 2011 State Health Plan results from the comments and information supplied by various
divisions of the Department of Health, other agencies of state government, health care provider
associations, and interested members of the public. The Plan also reflects the direction and guidance
of the Mississippi State Board of Health.

The Division of Health Planning and Resource Development expresses appreciation to the many
individuals who provided invaluable help in publishing a timely and accurate State Health Plan and
recognizes the following agencies for particular contributions:




Mississippi Department of Health                   Office of the Governor
    Communications                                 Mississippi Department of Human Services
    Health Information Management                  Mississippi Department of Mental Health
    Print Shop                                     Mississippi Department of Rehabilitation
                                                       Services
    Office of Health Protection                    Mississippi Department of Education
        Preparedness and Response                  University of Mississippi Medical Center
        Licensure                                      School of Medicine
        Communicable Disease                           School of Dentistry
        Environmental Health                           School of Health Related Professions
                                                   Board of Trustees of State Institutions
    Office of Health Services                          of Higher Learning
        Child\Adolescent Health                    Mississippi State Board of Medical
        Women’s Health                                 Licensure
        WIC Program                                Mississippi State Board of Nursing
                                                   Mississippi Dental Association
                                                   Mississippi Nurses' Association


Numerous other organizations provided essential information. The Health Planning staff appreciates
the cooperation and assistance of all who contributed to the 2011 Plan and wishes that space
permitted individual acknowledgment of each one.
.
                                 TABLE OF CONTENTS


HEALTH CARE SYSTEM

 Chapter 01-Introduction
      100 Legal Authority and Purpose …………………………………………………………....                                   1
      101 General Certificate of Need Policies …………………………………………………….                               2
      102 Population for Planning ………………………………………………………………….                                       2
      103 Health Personnel …………………………………………………………………………                                            4
         103.01 Physicians …………………………………………………………………………                                            4
         103.02 Dentists …………………………………………………………………...............                                  6
         103.03 Nurses …………………………………………………………………………….                                              8
                   Registered Nurses ………………………………………………………………                                      8
                   Nurse Practitioners ……………………………………………………………..                                   8
                   Licensed Practical Nurses ………………………………………………………                                 8
                   Office of Nursing Workforce Redevelopment …………………………………                         8
         103.04 Physical Therapy Practitioners …………………………………………………                                 9
         103.05 Occupational Therapists ………………………………………………………..                                    9
         103.06 Emergency Medical Personnel …………………………………………………                                    9
      104 Outline of the State Health Plan …………………………………………………………                                 10

HEALTH FACILITIES AND SERVICES/CERTIFICATE OF NEED
CRITERIA AND STANDARDS

 Chapter 02-Long-Term Care
      100 Options for Long-Term Care …………………………………………………………….                                      1
      101 Housing for the Elderly ………………………………………………………………….                                       1
      102 Nursing Facilities…………………………………………………………………………                                           4
      103 Long Term Care Beds for Individuals With Mental Retardation and Other
          Developmental Disabilities ……………………………………………………………...                                    4
      104 Certificate of Need Criteria and Standards for Nursing Home Beds …………………….               7
         104.01 Policy Statement Regarding Certificate of Need Applications for the
                    Offering of Nursing Home Care Services ………………………………………                         7
         104.02 Certificate of Need Criteria and Standards for Nursing Home Care Beds……...         8
         104.03 Certificate of Need Criteria and Standards for Nursing Home Beds As Part of a
                    Continuing Care Retirement Community (CCRC) …………………………….                       9
      105 Policy Statement Regarding Certificate of Need Applications for a Pediatric
         Skilled Nursing Facility …………………………………………………………………..                                     16
      106 Certificate of Need Criteria and Standards for Nursing Home Care Services for
          Mentally Retarded and other Developmentally Disabled Individuals ………………...…             16
         106.01 Policy Statement Regarding Certificate of Need Applications for the Offering
                    of Nursing Home Care Services for Mentally Retarded and Other
                    Developmentally Disabled Individuals………………………………………...                        16
         106.02 Certificate of Need Criteria and Standards for Nursing Home Beds for
                    Mentally Retarded and Other Developmentally Disabled Individuals…………          17




 2011 State Health Plan                        i                              Table of Contents
Chapter 03-Mental Health
     100 Mississippi Department of Mental Health ………………………………………….........                                1
     101 Mental Health Needs in Mississippi ……………………………………………………..                                        1
        101.01 Mental Health Needs of Children/Adolescents ………………………………...                                2
        101.02 National Survey on Drug Use and Health for Mississippi ……………………..                          2
        101.03 Developmental Disabilities …………………………………………….............                                  3
     102 Adult Psychiatric Services (State Operated and Private) ………………………..............                  3
     103 Child/Adolescent Psychiatric Services ………………………………………………….                                       6
     104 Psychiatric Residential Treatment Facilities …………………………………………….                                  8
     105 Alcohol and Drug Abuse Services………………………………………………………                                            10
        105.01 Alcohol and Drug Abuse ………………………………………………............                                     10
     106 Certificate of Need Criteria and Standards for Acute Psychiatric, Chemical
         Dependency, and Psychiatric Residential Treatment Facility Beds/Services ...................    17
        106.01 Policy Statement Regarding Certificate of Need Applications for Acute
                   Psychiatric Chemical Dependency, and Psychiatric Residential Treatment
                   Facility Beds/Services …………………………………………………………                                         17
        106.02 General Certificate of Need Criteria and Standards for Acute Psychiatric,
                   Chemical Dependency, and/or Psychiatric Residential Treatment Facility
                   Beds/Services ………………………………………………………………….                                              19
        106.03 Service Specific Certificate of Need Criteria and Standards for Acute
                   Psychiatric, Chemical Dependency and/or Psychiatric Residential Treatment
                   Facility Beds/Services …………………………………………………………                                         21
          106.03.01 Acute Psychiatric Beds for Adults …………………………………………                                   21
          106.03.02 Acute Psychiatric Beds for Children and Adolescents …………………….                        22
          106.03.03 Chemical Dependency Beds for Adults…………………………….............                          22
          106.03.04 Chemical Dependency Beds for Children and Adolescents………………..                        23
          106.04.05 Psychiatric Residential Treatment Facility Beds/Services ………………...                   23
     107 Private Distinct-Part Geriatric Psychiatric Services …………………………………….                            26

Chapter 04-Perinatal Care
     100 Natality Statistics ………………………………………………………………………..                                                1
     101 Infant Mortality ………………………………………………………………………….                                                   1
     102 Physical Facilities for Perinatal Care ……………………………………………………                                      3
     103 Certificate of Need Criteria and Standards for Obstetrical Services …………………….                    9
        103.01 Policy Statement Regarding Certificate of Need Applications for the Offering
                   of Obstetrical Services ………………………………………………………….                                        9
        103.02 Certificate of Need Criteria and Standards for Obstetrical Services …………...               10
     104 Certificate of Need Criteria and Standards for Neonatal Special Care Services ...............   15
        104.01 Policy Statement Regarding Certificate of Need Applications for the Offering
                   of Neonatal Special Care Services ……………………………………………..                                 15
        104.02 Certificate of Need Criteria and Standards for Neonatal Special Care Services
                   ………………………………………………………………………………….                                                      15
        104.03 Neonatal Special Care Services Bed Need Methodology………………………                              17
     105 Guidelines for the Operation of Perinatal Units (Obstetrics and Newborn
         Nursery) ………………………………………………………………………………….                                                       21
        105.01 Organization ……………………………………………………………………                                                   21
        105.02 Staffing …………………………………………………………………………                                                     21
        105.03 Levels of Care ………………………………………………………………….                                                 21
                     Basic Care-Level 1 …………………………………………………………..                                         21



Table of Contents                                 ii                            2011 State Health Plan
                     Specialty Care-Level 2……………………………………………………….                                  22
                     Sub-specialty Care-Level 3 ………………………………………………….                               22
        105.04     Perinatal Care Services………………………………………………………...                                 23
                   Antepartum Care ………………………………………………………………                                        23
                   Intra-partum Services: Labor and Delivery …………………………………..                       23
                   Newborn Care ………………………………………………………………….                                         24
                   Postpartum Care ………………………………………………………………..                                      24

Chapter 05-Acute Care
     100 General Medical/Surgical Hospitals …………………………………………………….                                   1
     101 Hospital Outpatient Services …………………………………………………………....                                    5
     102 Certificate of Need Criteria and Standards for General Acute Care ……………………                 9
        102.01 Policy Statement Regarding Certificate of Need Applications for General
                   Acute Care Hospitals and General Acute Care Beds ………………………….                     9
        102.02 Certificate of Need Criteria and Standards for the Establishment of a General
                   Acute Care Hospital ……………………………………………………………                                     11
        102.03 Certificate of Need Criteria and Standards for Construction, Renovation,
                   Expansion, Capital Improvements, Replacement of Health Care Facilities, and
                   Addition of Hospital Beds ……………………………………………………..                                11
     103 Long-Term Acute Care Hospitals ……………………………………………………….                                     17
     104 Certificate of Need Criteria and Standards for Long-Term Acute Care
         Hospitals/Beds …………………………………………………………………..............                                    18
        104.01 Policy Statement Regarding Certificate of Need Applications for Long-Term
                   Acute Care Hospitals and Long-Term Acute Care Hospital Beds …………….              18
        104.02 Certificate of Need Criteria and Standards for the Establishment of a Long-
                   Term Acute Care Hospital and Addition of Long-Term Acute Care Hospital
                   Beds ……………………………………………………………………………                                              20
     105 Swing-Bed Programs and Extended Care Services ……………………………..............                   23
        105.01 Swing Bed Utilization………………………………………………………….                                        23
        105.02 Certificate of Need Criteria and Standards for the Establishment for a Swing
                   Bed Service …………………………………………………………………….                                         26
     106 Therapeutic Radiation Services………………………………………………………….                                     29
     107 Stereotactic Radiosurgery ……………………………………………………………….                                       29
     108 Diagnostic Imaging Services …………………………………………………………….                                      30
     109 Certificate of Need Criteria and Standards for Therapeutic Radiation Services…………         32
        109.01 Policy Statement Regarding Certificate of Need Applications for the
                   Acquisition or Otherwise Control of Therapeutic Radiation Equipment, and/or
                   the Offering of Therapeutic Radiation Services (other than Stereotactic
                   Radiosurgery) …………………………………………………………………..                                       32
        109.02 Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                   Control of Therapeutic Radiation Equipment and/or the Offering of
                   Therapeutic Radiation Services (other than Stereotactic Radiosurgery)
                   ………………………………………………………………………………….                                                33
          109.02.01 Therapeutic Radiation Equipment/Service Need Methodology ……………                 35
          109.02.01Therapeutic Radiation Equipment Need Determination Formula …………..               35
        109.03 Policy Statement Regarding Certificate of Need Applications for the
                   Acquisition or Otherwise Control of Stereotactic Radiosurgery Equipment
                   and/or the Offering of Stereotactic Radiosurgery ……………………………...                 36




2011 State Health Plan                        iii                              Table of Contents
        109.04     Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                   Control of Stereotactic Radiosurgery Equipment and/or the Offering of
                   Stereotactic Radiosurgery ………………………………………………………                                   37
     110 Computed Tomographic (CT) Scanning …………………………………………………                                      41
        110.01 Magnetic Resonance Imaging (MRI) …………………………………………..                                   41
     111 Digital Subtraction Angiography (DSA) ………………………………………...............                        45
     112 Positron Emission Tomography (PET) ………………………………………………….                                     47
        112.01 Certificate of Need Criteria and Standards for Magnetic Resonance
                Imaging Services (MRI) ………………………………………………………….                                       49
          112.01.01 Policy Statement Regarding Certificate of Need Applications for the
                       Acquisition or Otherwise Control of Magnetic Resonance Imaging
                      (MRI) Equipment and/or the Offering of MRI Services …………………….                  49
          112.01.02 Certificate of Need Criteria and Standards for Acquisition or
                       Otherwise Control of Magnetic Resonance (MRI) Equipment and/or
                       the Offering of MRI Services ……………………………………………….                              50
          112.01.03 Certificate of Need Criteria and Standards for Acquisition or
                        Otherwise Control of MRI Equipment ……………………………………..                          50
          112.01.04 Certificate of Need Criteria and Standards for the Offering of Fixed
                       or Mobile MRI Services …………………………………………………….                                  51
          112.01.05 Population-Based Formula for Projection of MRI Service Volume………...              54
     113 Certificate of Need Criteria and Standards for Diagnostic Imaging Services……………             54
        113.01 Certificate of Need Criteria and Standards for Digital Subtraction Angiography
                   ………………………………………………………………………………….                                                  54
        113.02 Positron Emission Tomography (PET) Equipment and Services………………                       55
          113.02.01 Policy Statement Regarding Certificate of Need Applications for
                       the Acquisition or Otherwise Control of a Position Emission
                       Tomography (PET) Scanner and Related Equipment ………………………                      55
          113.02.02 Certificate of Need Criteria and Standards for Acquisition or
                       Otherwise Control of a Positron Emission Tomography (PET)
                       Scanner and Related Equipment ……………………………………………                               57
          113.02.03 Certificate of Need Criteria and Standards for the Offering of Fixed
                        or Mobile Positron Emission Tomography (PET) Services ……………….                58
     114 Cardiac Catheterization ………………………………………………………………….                                          63
     115 Certificate of Need Criteria and Standards for Cardiac Catheterization Services
         and Open-Heart Surgery Services ……………………………………………………….                                      65
        115.01 Joint Policy Statement Regarding Certificate of Need Applications for the
                   Acquisition or Otherwise Control of Cardiac Catheterization Equipment and/or
                   the Offering of Cardiac Catheterization Services and the Acquisition of Open-
                   Heart Surgery Equipment and/or the Offering of Open-Heart Surgery Services
                   ………………………………………………………………………………….                                                  65
        115.02 Policy Statement Regarding Certificate of Need Applications for the
                   Acquisition or Otherwise Control of Cardiac Catheterization Equipment and/or
                   the Offering of Cardiac Catheterization Services ………………………………                     66
        115.03 Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                   Control of Diagnostic Cardiac Catheterization Equipment and/or the Offering
                   of Diagnostic Cardiac Catheterization Services ……………………………….                      68




Table of Contents                              iv                           2011 State Health Plan
        115.04  Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                Control of Therapeutic Cardiac Catheterization Equipment and/or the Offering
                of Therapeutic Cardiac Catheterization Services ………………………………                     69
     116 Open-Heart Surgery ……………………………………………………………………...                                        75
        116.01 Policy Statement Regarding Certificate of Need Applications for the
                Acquisition of Open-Heart Surgery Equipment and/or the Offering of
                Open-Heart Surgery Services…………………………………………………...                                77
        116.02 Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                Control of Open-Heart Surgery Equipment and/or the Offering of Open-Heart
                Surgery Services………………………………………………………………..                                       78
     117 Trauma…………………………………………………………………………………...                                                81
        117.01 Mississippi Trauma Care System ………………………………………………                                 81
        117.02 Current Status of Mississippi Trauma Care ……………………………………                          82
        117.03 Emergency Medical Services …………………………………………………..                                  82

Chapter 06-Comprehensive Medical Rehabilitation Services
     100 Comprehensive Medical Rehabilitation Services ………………………………………..                          1
     101 The Need for Comprehensive Medical Rehabilitation Services …………………………                    2
     102 The Need for Comprehensive Children's Medical Rehabilitation Services ……………...           2
     103 Certificate of Need Criteria and Standards for Comprehensive Medical
          Rehabilitation Beds/Services ……………………………………………………………                                    5
        103.01 Policy Statement Regarding Certificate of Need Applications for
                   Comprehensive Medical Rehabilitation Beds/Services ………………………..                 5
        103.02 Certificate of Need Criteria and Standards for Comprehensive Medical
                   Rehabilitation Beds/Services ………………………………………………..…                             7
        103.03 Certificate of Need Criteria and Standards for Children's Comprehensive
                   Medical Rehabilitation Beds/Services …………………………………………                          9
        103.04 Comprehensive Medical Rehabilitation Bed Need Methodology ……………..                  9

Chapter 07-Other Health Services
     100 Ambulatory Surgery Services …………………………………………………………….                                     1
     101 Certificate of Need Criteria and Standards for Ambulatory Surgery Services …………..        7
       101.01 Policy Statement Regarding Certificate of Need Applications for
                  Ambulatory Surgery Services …………………………………………..............                      7
       101.02 Certificate of Need Criteria and Standards for Ambulatory Surgery
                  Services…………………………………………………………………………                                            8
     102 Home Health Care ………………………………………………………………………                                            13
       102.01 Home Health Status…………………………………………………………….                                         13
     103 Certificate of Need Criteria and Standards for Home Health Agencies/Services ……….       16
       103.01 Policy Statement Regarding Certificate of Need Applications for the
                  Establishment of a Home Health Agency and/or the Offering of Home Health
                  Services………………………………………………………….. ……………...                                      16
       103.02 Certificate of Need Criteria and Standards for the Establishment of a Home
                  Health Agency and/or the Offering of Home Heath Services ………………….              16




2011 State Health Plan                        v                              Table of Contents
        103.03 Statistical Need Methodology for Home Health Services ………………………              17
     104 End Stage Renal Disease …………………………………………………………………                                  21
     104 Certificate of Need Criteria and Standards for End Stage Renal Disease
         Facilities …………………………………………………………………………………                                         27
        104.01 Policy Statement Regarding Certificate of Need Applications for the
                  Establishment of End Stage Renal Disease (ESRD) Facilities …………………        27
        104.02 Certificate of Need Criteria and Standards for End Stage Renal Disease
                  (ESRD) Facilities ………………………………………………………………                                29
          104.02.01 Establishment of an End Stage Renal Disease (ESRD) Facility ……………       30
          105.02.02 Establishment of a Renal Transplant Center ………………………………..               33

GLOSSARY
     Glossary ………………………………………………………………………………………                                              1

APPENDIX
     Appendix ………………………………………………………………………………………                                              1




Table of Contents                         vi                       2011 State Health Plan
HEALTH CARE SYSTEM
.
 CHAPTER 1
INTRODUCTION
                    Title 15 - Mississippi Department of Health

                  Part IX – Office of Health Policy and Planning

               Subpart 90 – Planning and Resource Development


Chapter 01               Introduction
100    Legal Authority and Purpose

        Section 41-7-171 et seq., Mississippi Code 1972 Annotated, as amended, established the
Mississippi State Department of Health (MSDH) as the sole and official agency to administer and
supervise all health planning responsibilities for the state, including development and publication
of the Mississippi State Health Plan. The effective dates of the Fiscal Year 2011 Mississippi
State Health Plan extend from September 8, 2010, through September 7, 2011, or until
superseded by a later Plan.

        The 2011 State Health Pan establishes criteria and standards for health-related activities
which require Certificate of Need review in an effort to meet the priority health needs identified
by the department. The priority health needs are as follows:

             Disease prevention, health protection, and health promotion

             Health care for specific populations, such as mothers, babies, the elderly, the
             indigent, the uninsured, and minorities

             Implementation of a statewide trauma system

             Health needs of persons with mental illness, alcohol/drug abuse problems, mental
             retardation/developmental disabilities, and/or handicap

             Availability of adequate health manpower throughout the state.

               Enhance capacity for detention of a response to public health emergencies,
               including acts of bioterrorism

         Section 41-7-191, Mississippi Code 1972 Annotated, as amended, requires Certificate of
Need (CON) approval for the establishment, relocation, or expansion of health care facilities. The
statute also requires CON approval for the acquisition or control of major medical equipment and
for the change of ownership of defined health care facilities unless the facilities meet specific
requirements.

        This Plan provides the service-specific CON criteria and standards developed and adopted
by the MSDH for CON review of health-related activities requiring such review. The Mississippi
Certificate of Need Review Manual provides additional general CON criteria by which the
Department reviews all applications.

2011 State Health Plan                           1                           Chapter 1 – Introduction
 101     General Certificate of Need Policies

      Mississippi's health planning and health regulatory activities have the following purposes:

                To improve the health of Mississippi residents

                To increase the accessibility, acceptability, continuity, and quality of health services.

                To prevent unnecessary duplication of health resources

                To provide some cost containment

      The MSDH intends to approve an application for CON if it substantially complies with the
      projected need and with the applicable criteria and standards presented in this Plan, and to
      disapprove all CON applications which do not substantially comply with the projected need or
      with applicable criteria and standards presented in this Plan.

      The MSDH intends to disapprove CON applications which fail to confirm that the applicant
      shall provide a reasonable amount of indigent care, or if the applicant’s admission policies
      deny or discourage access to care by indigent patients. Furthermore, the MSDH intends to
      disapprove CON applications if such approval would have a significant adverse effect on the
      ability of an existing facility or service to provide indigent care. Finally, it is the intent of the
      Mississippi State Department of Health to strictly adhere to the criteria set forth in the State
      Health Plan and to ensure that any provider desiring to offer healthcare services covered by
      the Certificate of Need statutes undergoes review and is issued a Certificate of Need prior to
      offering such services.

      The State Health Officer shall determine whether the amount of indigent care provided or
      proposed to be offered is "reasonable." The Department considers a reasonable amount of
      indigent care as that which is comparable to the amount of such care offered by other
      providers of the requested service within the same, or proximate, geographic area.

      The MSDH may use a variety of statistical methodologies including, but not limited to, market
      share analysis or patient origin data to determine substantial compliance with projected need
      and with applicable criteria and standards in this Plan.


102    Population for Planning

      Population projections used in this Plan were calculated by the Center for Policy Research and
      Planning, Mississippi Institutions of Higher Learning, as published in MISSISSIPPI,
      Population Projections for 2010, 2015, and 2020, August 2005. This plan is based on 2010
      population projections. Map 1-1 depicts the state's 2010 estimated population by county.
      Mississippi population projections for the years 2015 and 2020 can be obtained form the State
      Institutions of Higher Learning at www.ihl.state.ms.us. (1) Select University Research Center;
      2) Economics; and 3) Miss Population Projections)




 2011 State Health Plan                                2                            Chapter 1 – Introduction
                                 Map 1-1
                           Population Projections
                                    2010




State Total -- 2,975,551




2011 State Health Plan               3              Chapter 1 – Introduction
103 Health Personnel

      High quality health care services depend on the availability of competent health personnel
      in sufficient numbers to meet the population's needs. Mississippi is traditionally a medically
      underserved state, particularly in sparsely populated rural areas and areas containing large
      numbers of poor people, elderly people, and minorities. This section discusses some of the
      areas of greatest need for health care personnel, focusing on physicians, dentists, and
      nurses.


  103.01 Physicians

          Mississippi had 5,234 active medical doctors, 307 osteopaths, and 65 podiatrists
          licensed by the Board of Medical Licensure for FY 2009 (licensing year 2010) for a
          total of 5,606 active licensed physicians practicing in the state. This number represents
          an increase of 58 physicians, or more than 1.05 percent, from FY 2008 (licensing year
          2009).

          Approximately 2,216 (42.3 percent) of the state's active medical doctors are primary
          care physicians, representing a ratio of one primary care physician for every 1,351
          persons, based on 2010 projected population. The primary care physicians included 745
          family practitioners, 102 general practitioners, 677 internal medicine physicians, 309
          obstetrical and gynecological physicians, and 382 pediatricians. Map 1-2 depicts the
          total number of primary care medical doctors by county.

          Mississippi had 77 counties or portions of counties designated as health professional
          shortage areas for primary medical care for March 2010. The United States Department
          of Health and Human Services defines a health professional shortage area (HPSA) as a
          geographic area that has a ratio of at least 3,500 persons per primary care physician and
          insufficient access to those physicians within a 30 minute traveling radius. Also, areas
          with 3,000 to 3,500 persons per primary care physician that have unusually high needs
          for primary care services and have insufficient access to primary care doctors within a
          30 minute traveling radius, can also be designated as a HPSA




Chapter 1 – Introduction                         4                            2011 State Health Plan
                                      Map 1 -2
             Active Primary Care Medical Doctors by County of Residence
                                     FY 2009




2011 State Health Plan                   5                     Chapter 1 – Introduction
        103.02 Dentists

          The Mississippi State Board of Dental Examiners reported 1,503 licensed (1,274
          ―active‖ and 229 ―inactive‖) dentists in the state as of April 2010, with 42 new dentists
          licensed during calendar year 2009. Based on Mississippi's 2010 projected population
          of 2,975,551, the state has one active dentist for every 2,336 persons.

          The more populated areas of Mississippi are sufficiently supplied with dentists;
          however, many rural areas still face tremendous shortages. According to Health
          Resources and Services Administration’s Shortage Designation Branch (HRSA/SDB),
          Mississippi currently has 74 dental HPSAs, which includes 72 single county
          designations.

          Mississippi's two major population centers contain the most active dentists. The
          Jackson area had a total of 372 active dentists in the spring of 2010, with 184 in Hinds
          County, 95 in Rankin County, and 94 in Madison County. The Gulf Coast region had
          the second largest count at 161, with 91 in Harrison County, 59 in Jackson County, and
          11 in Hancock County. Combined, these two metropolitan areas contained 42 percent
          of the state's total supply of active dentists.

          On the opposite end of the spectrum, eight counties— Amite, Carroll, Claiborne,
          Greene, Jefferson, Kemper, Quitman, and Webster—had only one active dentist each
          and six counties—Benton, Franklin, Humphreys, Issaquena, Tunica, and Sharkey—had
          no active dentist. Map 1-3 depicts the number of dentists per county and indicates the
          number of in-state, active, licensed dentists who have mailing addresses in the state.




Chapter 1 – Introduction                         6                            2011 State Health Plan
                                 Map 1-3
                         Active Dentists by County




2011 State Health Plan          7                    Chapter 1 – Introduction
        103.03 Nurses

          Registered Nurses

          The Mississippi Board of Nursing reported 37,105 registered nurses (RNs) with active
          licensure in Mississippi for FY 2009 and another 1,309 with inactive licensure. Of
          those with active licensure, 83.9 percent (32,361) worked full or part-time in nursing
          careers. This number includes 20,036 (61.9 percent) in hospitals; 3,342 (10.3 percent)
          in community, public, or home health; 2,258 (7%) in physicians’ offices; 1,633 (5
          percent) in nursing homes; and the remainder in other nursing careers. RNs by degree
          in FY 2009 included 1,465 diploma, 17,001 associates, 1,069 baccalaureate non-
          nursing, 9,037 baccalaureate nursing, 653 masters non-nursing, 2,934 masters nursing,
          and 202 doctorate degrees. For more statistical information on nurses, see the
          Mississippi Board of Nursing website at www.msbn.state.ms.us.

          Nurse Practitioners

          Nurse Practitioner includes any person licensed to practice nursing in Mississippi and
          certified by the Board of Nursing to practice in an expanded role as a nurse practitioner
          (NP). For FY 2009, there were 2,222 RNs certified for expanded role nursing as nurse
          practitioners. The majority of these (56.5 percent) were family NPs; 25 percent were
          certified registered nurse anesthetists, and the remainder practiced in such specialties as
          acute care, mental health, gerontology, midwifery, and others.

          Licensed Practical Nurses

          The Board of Nursing reported 13,274 licensed practical nurses (LPNs) with active
          licensure in Mississippi for FY 2009 and another 612 with inactive licensure. Of those
          with active licensure, 76.2 percent (10,596) worked full or part-time in nursing careers.
          This number includes 3,872 (36.5 percent) in nursing homes; 2,691 (25.4 percent) in
          hospitals; 1,907 (18.1 percent) in physicians’ offices; 747 (7 percent) in community,
          public, or home health; and the remainder in other nursing careers. There were 2,905
          LPNs certified for an expanded role in FY 2009, including 2,752 in intravenous
          therapy, 101 in hemodialysis, and 52 in both expanded roles.

          Office of Nursing Workforce Redevelopment

          The Mississippi Nursing Organization Liaison Committee (NOLC), a committee of the
          Mississippi Nurses Association composed of representation from 25 nursing
          organizations, has worked proactively to address nursing workforce issues related to
          anticipated changes in nursing and the health care delivery system. Through the efforts
          of the NOLC, the Mississippi Legislature passed the Nursing Workforce
          Redevelopment Act during the 1996 Session. The Act authorized the Mississippi Board
          of Nursing to establish an entity that would be responsible for addressing changes
          impacting the nursing workforce.

          Currently, with funding from the legislature and the Mississippi Development
          Authority, Office of Nursing Workforce Redevelopment (ONWR) is working with
          the Mississippi Council of Deans and Directors of Schools of Nursing, the Mississippi
          Nurses Association and the Mississippi Organization of Nurse Executives to address



Chapter 1 – Introduction                         8                             2011 State Health Plan
          issues vital to nursing. These issues include faculty shortages, barriers to nursing
          education, recruitment into nursing, scholarship funding, the image of nursing,
          service/education collaboratives, retention of nursing service employees, and leadership
          training for nurses. More information is available by calling ONW or visiting
          www.monw.org.

        103.04 Physical Therapy Practitioners
          Physical therapy (PT) practitioners provide preventive, diagnostic, and rehabilitative
          services to restore function or prevent disability from disease, trauma, injury, loss of a
          limb, or lack of use of a body part to individuals of all ages.
          The Mississippi State Board of Physical Therapy reported 1516 licensed physical
          therapists in Mississippi as of March 2010. Twenty two percent of the Mississippi
          resident physical therapy practitioners live in Hinds County, eight percent in Harrison
          County, and eleven percent in Madison County, for a total of 41 percent in three
          counties. Mississippi ranks 39th in the United States for the ratio of therapists per
          100,000 population. The Board also reported 779 licensed physical therapist assistants,
          with 655 practicing in the state.
        103.05 Occupational Therapist
          Occupational therapy is a health and rehabilitation profession that serves people of all
          ages who are physically, psychologically, or developmentally disabled. Their functions
          range from diagnosis to treatment, including the design and construction of various
          special and self-help devices. OTs direct their patients in activities designed to help
          them learn skills necessary to perform daily tasks, diminish or correct pathology, and
          promote and maintain health.
          The MSDH reported 837 licensed occupational therapists and 359 certified
          occupational therapy assistants on its Mississippi roster as of April 21, 2010, with 721
          of the OTs and 309 of the OTAs residing in the state.
        103.06 Emergency Medical Personnel
          The training of emergency medical personnel includes ambulance drivers and
          emergency medical technicians (EMTs) of both advanced and basic levels. Mississippi
          requires all ambulance drivers to have EMS driver certification (EMS-D). To qualify,
          an individual must complete an approved driver training program that involves driving
          tasks, vehicle dynamics, vehicle preventative maintenance, driver perception, night
          driving, and information on different driving maneuvers. This training offers both
          academic and clinical (practical hands on) experiences for the prospective ambulance
          driver. In FY 2009, Mississippi had 2,534 EMS certified drivers.
          Additionally, all emergency medical technicians – both advanced level and basic level
          – must complete a National Highway Safety and Traffic Administration training
          program for the respective level. This training provides extensive academic and
          clinical hours for the prospective students. Upon completion, students must pass the
          National Registry for Emergency Medical Technicians test and receive their national
          certification before applying for the Mississippi certification.

          For FY 2009, the MDH Bureau of Emergency Medical Services reported a total of 920
          EMT Basics certified in the state; 1,160 EMT Paramedics; and 27 EMT intermediates.




2011 State Health Plan                            9                           Chapter 1 – Introduction
          The Legislature authorized the MDH Bureau of Emergency Medical Services (BEMS)
          to certify Mississippi’s medical first responders beginning July 1, 2004. In fiscal year
          2009, BEMS has certified 28 medical first responders.

104 Outline of the State Health Plan

   The State Health Plan describes existing services, evaluates the need for additional services in
   various aspects of health care, and provides Certificate of Need (CON) criteria and standards
   for each service requiring CON review. These services include: long-term care, including care
   for the aged and the mentally retarded; mental health care, including psychiatric, chemical
   dependency, and long-term residential treatment facilities; perinatal care; acute care, including
   various types of diagnostic and therapeutic services; ambulatory care, including outpatient
   services and freestanding ambulatory surgical centers; comprehensive medical rehabilitation;
   home health services; and end stage renal disease facilities.

   The Glossary contains definitions of terms and phrases used in this Plan.




Chapter 1 – Introduction                        10                             2011 State Health Plan
   HEALTH FACILITIES AND
SERVICES/CERTIFICATE OF NEED
  CRITERIA AND STANDARDS
.
  CHAPTER 2
LONG-TERM CARE
Chapter 02 Long-Term Care
“Long-term care” simply means assistance provided to a person who has chronic conditions that
reduce their ability to function independently. Many people with severe limitations in their ability to
care for themselves are able to remain at home or in supportive housing because they have sufficient
assistance from family, friends, or community services.

Mississippi’s long-term care (nursing home and home health) patients are primarily disabled elderly
people, who make up 20 percent of the 2025 projected population above age 65. Projections place the
number of people in this age group at approximately 642,506 by 2025, with more than 186,327
disabled in at least one essential activity of daily living.

The risk of becoming frail, disabled, and dependent rises dramatically with age. While the average
length of life has increased, people are often living longer with some very disabling chronic
conditions which the present medical system can “manage” but not cure. So while the lives of many
people have been prolonged through advances in medicine and public health, the quality of an older
person’s life often suffers. Aged individuals may become dependent on medical technology and
professional care providers for years - not just weeks or months.


100 Options for Long-Term Care

   Several programs for individuals with infirmities serve, if properly used, can delay or avoid
   institutionalization. These programs, although not reviewable through Certificate of Need
   authority, drastically affect the demand for skilled nursing beds.

   Community services play a vital role in helping the elderly maintain some degree of
   independence. Examples of community-based elder-care include adult day care, senior centers,
   transportation, meals on wheels or meals at community locations, and home health services. More
   information concerning such services can be obtained by contacting the Mississippi Department of
   Human Services, Division of Aging and Adult Services.


101 Housing for the Elderly

   Many elderly or infirmed people do not need skilled nursing care on a daily basis, but simply safe,
   affordable housing and some assistance with the activities of daily living. Such housing can take
   many forms.

   “Board and care homes” are residences providing rooms (often semi-private), shared common
   areas, meals, protective oversight, and help with bathing, dressing, grooming, and other daily
   needs. In Mississippi, these facilities are licensed as personal care homes: Personal Care Home -
   Residential Living and Personal Care Home - Assisted Living. Both of these facilities provide
   residents a sheltered environment and assistance with the activities of daily living. Additionally,
   Personal Care Homes - Assisted Living may provide additional supplemental medical services that
   include the provision of certain routine health maintenance and emergency response services. In
   December of 2009, the state had 164 licensed personal care homes, with a total of 5,090 licensed
   beds. Personal care facilities presently are not reviewable under Certificate of Need authority.




2011 State Health Plan                               1                      Chapter 2 – Long-Term Care
   “Retirement communities” or “senior housing facilities” have become common around the state.
   These communities usually provide apartments for independent living, with services such as
   transportation, weekly or bi-weekly housekeeping, and one to three meals daily in a common
   dining room. Many of these facilities include a licensed personal care home where the resident
   may move when he or she is no longer physically or mentally able to remain in their own
   apartment. Most facilities do not require an initial fee and do not sign a lifetime contract with their
   residents. They generally offer only independent living and personal care - most do not include a
   skilled nursing home as a part of the retirement community. Table 8-1 shows the distribution of
   personal care facilities by Long-Term Care Planning Districts.

                                         Table 2-1
       Personal Care Home Licensed Beds, Occupancy Rates and Average Daily Census
                                          2008

                        District I                                              District II
                                             Average                                                   Average
                     Licensed Occupancy       Daily                          Licensed    Occupancy      Daily
       County          Beds    Rate %        Census             County         Beds       Rate %       Census
    Attala              40      78.46          36.12        Alcorn              69         68.20        45.88
    Bolivar            149      76.22         102.68        Benton              24          N/A          N/A
    Carroll              0       0.00          0.00         Calhoun             20         78.25        15.65
    Coahoma             36      89.40          32.19        Chickasaw           24         24.84         5.96

    DeSoto             139           69.62    94.02         Choctaw             14            86.60     12.12
    Grenada             58           81.28    48.44         Clay                28            70.32     18.03
    Holmes              16           40.73    6.52          Itawamba           119            37.25     50.22
    Humphreys           0             0.00    0.00          Lafayette          154            82.77     124.02

    Leflore            74            93.66    68.73         Lee                391            74.15     267.70
    Montgomery         0              0.00    0.00          Lowndes            213            67.23     141.88
    Panola             54            89.43    48.29         Marshall            46            80.62     37.09
    Quitman            0              0.00    0.00          Monroe              95            88.96     87.48

    Sunflower          52            77.54    26.97         Noxubee            25             69.80     18.45
    Tallahatchie       0              0.00    0.00          Oktibbeha          69             51.71     21.78
    Tate               0              0.00    0.00          Pontotoc           40              N/A       N/A
    Tunica             0              0.00    0.00          Prentiss           40             49.58     19.83

    Washington         103           64.47    64.42         Tippah              10            54.62      5.46
    Yalobusha           2             N/A      N/A          Tishomingo         117            97.48     167.64
                                                            Union               84            92.41     78.70
                                                            Webster             13             N/A       N/A

                                                            Winston            47             73.22     34.35



    District Total     723           76.08   528.38         District Total    1,642           69.33    1,152.24




Chapter 2 – Long-Term Care                             2                              2011 State Health Plan
                                     Table 2-1 (Continued)
         Personal Care Home Licensed Beds, Occupancy Rates and Average Daily Census
                                            2008

                      District III                                                    District IV
                                     Average                                                                Average
                  Licensed Occupancy  Daily                                        Licensed Occupancy        Daily
   County           Beds    Rate %   Census                          County          Beds    Rate %         Census
Adams                60      86.52    54.82                       Clarke              20      74.59           14.92
Amite                 0        0        0                         Covington           36      73.02          26.29
Claiborne             0        0        0                         Forrest            182      81.14          155.12
Copiah                0        0        0                         George              24      52.28           13.63

Franklin              0             0            0                Greene              0           0.00        0.00
Hinds                383          82.77        270.88             Hancock            12          38.82        3.88
Issaquena             0             0            0                Harrison           179         61.66       116.65
Jefferson             0             0            0                Jackson            64          94.56        58.45

Lawrence             22           62.75         13.66             Jasper             48          49.73        23.87
Lincoln              36           55.32         19.60             Jeff Davis          0           0.00        0.00
Madison              327          84.16        260.67             Jones              187         59.96       126.68
Pike                 98           62.66         60.90             Kemper              0           0.00        0.00

Rankin               245          64.66        160.33             Lamar              176         67.52        45.23
Sharkey               0             0             0               Lauderdale         183         81.06       136.14
Simpson              33           91.53         19.22             Leake               0           0.00        0.00
Walthall              0             0             0               Marion             19          63.64        7.00

Warren                84          74.14         64.27             Neshoba            34          66.35        20.07
Wilkinson             0             0             0               Newton             64          86.21        32.29
Yazoo                 0             0             0               Pearl River        117         69.14        62.31
                                                                  Perry              22          80.68        17.36

                                                                  Scott              12          97.88        11.75
                                                                  Smith               0           0.00        0.00
                                                                  Stone               1           N/A          N/A
                                                                  Wayne              57          67.28        36.77

District Total      1,288         73.83        924.35             District Total    1,437        70.31       908.41

State Total                                                                           5,090         72.42     3,513.38

Note: State total occupancy rate of 72.42% is based on 4,788 beds.

Source: 2008 Report on Institutions for the Aged or Infirm, December 2009; MSDH, Bureau of Health Facilities Licensure
and Certification

Another type of retirement center, called a “continuing care retirement community” (CCRC) includes
three stages: independent living in a private apartment, a personal care facility, and a skilled nursing
home. Residents of this type of facility enter into a contract whereby the residents pay a substantial
fee upon entering the CCRC and the facility agrees to provide care for the remainder of the residents’
lives. Table 2-2 shows the distribution of CCRCs within the state.



2011 State Health Plan                                        3                           Chapter 2 – Long-Term Care
                                                 Table 2-2
                               Continuing Care Retirement Community (CCRC)

                                                                                              Licensed
      County                Facility                                                         CCRC Beds           LTCPD
      Hancock               Woodland Village Nursing Center                                      33                IV
      Lamar                 Windham House of Hattiesburg                                         30                IV
      Madison               The Arbor Skilled Nursing Facility                                   60                III
      Pike                  Camellia Estates                                                     30                III
      Rankin                Brandon Court Nursing Home                                           40                III
      Rankin                Wisteria Gardens                                                     52                III
      Stone                 Stone County Nursing & Rehab Center                                  39                IV
      Total                                                                                     284
      Source: Mississippi State Department of Health, Division of Licensure and Certification; and Division of Health Planning
      and Resource Development

102 Nursing Facilities

   As of June 2010, Mississippi has 188 public or proprietary skilled nursing homes, with a total of
   17,381 licensed beds. Four entities have received CON approval for the construction of 240
   additional nursing home beds, and 17 facilities have voluntarily de-licensed a total of 525 nursing
   home beds which are being held in abeyance by MSDH. This count of licensed nursing home beds
   excludes 120 beds operated by the Mississippi Band of Choctaw Indians; 694 licensed beds
   operated by the Department of Mental Health; a total of 284 beds in continuing care retirement
   communities (CCRCs); 600 operated by the Mississippi State Veteran's Affairs Board, and 60
   beds (which are dedicated to serving patients with special rehabilitative needs, including spinal
   cord and closed-head injuries) operated by Mississippi Methodist Rehabilitation Center. These
   beds are not subject to Certificate of Need review and are designated to serve specific populations.

   Map 2-1 shows the general Long-Term Care Planning Districts and Table 2-3 presents the
   projected nursing home bed need for 2015 by planning district. Both the map and table appear in
   the criteria and standards section of this chapter. For 2020 projections see Appendix.


103 Long-Term Care Beds for Individuals with Mental Retardation and Other
    Developmental Disabilities

   Mississippi has 2,765 licensed beds classified as ICF/MR (intermediate care facility for the
   mentally retarded). The Department of Mental Health (MDMH) operates five comprehensive
   regional centers that contain 2,076 active licensed and staffed beds. There are also six proprietary
   facilities operate the remaining 689 beds. The residents of the MDMH’s regional centers, although
   they have mental retardation/developmental disabilities, also have severe physical disabilities that
   result in their requiring care at the nursing home level. Regular nursing facilities are not equipped
   to serve these individuals. Map 2-2 shows the MR/DD Long-Term Care Planning Districts and
   Table 2-4 presents the MR/DD nursing home bed need by Planning District. Both the map and
   table appear in the criteria and standards section of this chapter.




Chapter 2 – Long-Term Care                                      4                                   2011 State Health Plan
 CERTIFICATE OF NEED
CRITERIA AND STANDARDS
         FOR
  NURSING HOME BEDS
104      Certificate of Need Criteria and Standards for Nursing Home Beds

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of a
   service for which specific CON criteria and standards have not been adopted, the application shall be
   deferred until the Department of Health has developed and adopted CON criteria and standards. If the
   Department has not developed CON criteria and standards within 180 days of receiving a CON
   application, the application will be reviewed using the general CON review criteria and standards
   presented in the Mississippi Certificate of Need Review Manual and all adopted rules, procedures, and
   plans of the Mississippi State Department of Health.


      104.01        Policy Statement Regarding Certificate of Need Applications for the Offering of
                    Nursing Home Care Services

               1.     Legislation

                       a. The 1990 Mississippi Legislature imposed a permanent moratorium which
                          prohibits the MSDH from granting approval for or issuing a Certificate of Need to
                          any person proposing the new construction of, addition to, expansion of, or
                          conversion of vacant hospital beds to provide skilled or intermediate nursing home
                          care, except as specifically authorized by statute.

                       b. Effective July 1, 1990, any health care facility defined as a psychiatric hospital,
                          skilled nursing facility, intermediate care facility, intermediate care facility for the
                          mentally retarded, or psychiatric residential treatment facility that is owned by the
                          State of Mississippi and under the direction and control of the State Department of
                          Mental Health is exempted from the requirement of the issuance of a Certificate of
                          Need under Section 41-7-171 et seq., for projects which involve new construction,
                          renovation, expansion, addition of new beds, or conversion of beds from one
                          category to another in any such defined health care facility.

                       c. The 1999 Mississippi Legislature temporarily lifted the 1990 moratorium to allow
                          a 60-bed nursing facility to be added to each of 26 counties with the greatest need
                          between the years 2000 and 2003. The Legislature also permitted CONs for 60
                          nursing facility beds for individuals with Alzheimer’s disease in the northern,
                          central, and southern parts of each of the Long-Term Care Planning Districts, for a
                          total of 240 additional beds.

                       d. Effective April 12, 2002, no health care facility shall be authorized to add any beds
                          or convert any beds to another category of beds without a Certificate of Need.

                       e. Effective March 4, 2003, if a health care facility has voluntarily delicensed some
                          of its existing bed complement, it may later relicense some or all of its delicensed
                          beds without the necessity of having to acquire a Certificate of Need. The
                          Department of Health shall maintain a record of the delicensing health care facility
                          and its voluntarily delicensed beds and continue counting those beds as part of the
                          state’s total bed count for health care planning purposes.




   2011 State Health Plan                                    7                       Chapter 2 – Long-Term Care
                       f. A health care facility that has ceased to operate for a period of 60 months
                       (five years) or more shall require a Certificate of Need prior to reopening.

                       g. Long-Term Care Planning Districts (LTCPD): The MSDH shall determine
                          the need for additional nursing home care beds based on the LTCPDs as
                          outlined on Map 2-1. The MSDH shall calculate the statistical need for beds
                          in each LTCPD independently of all other LTCPDs.

           2.     Bed Need: The need for nursing home care beds is established at:

                     0.5 beds per 1,000 population aged 64 and under
                     10 beds per 1,000 population aged 65-74
                     36 beds per 1,000 population aged 75-84
                     135 beds per 1,000 population aged 85 and older

           3.     Population Projections: The MSDH shall use population projections as presented in
                  Table 2-3 when calculating bed need. These population projections are the most recent
                  projections prepared by the Center for Policy Research and Planning of the Institutions
                  of Higher Learning.

           4.     Bed Inventory: The MSDH shall review the need for additional nursing home beds
                  using the most recent information available regarding the inventory of such beds.

           5.     Size of Facility: The MSDH shall not approve construction of a new or replacement
                  nursing home care facility for less than 60 beds. However, the number of beds
                  authorized to be licensed in a new or replacement facility may be less than 60 beds.

           6.     Definition of CCRC: The Glossary of this Plan presents the MSDH’s definition of a
                  “continuing care retirement community” for the purposes of planning and CON
                  decisions.

           7.     Medicare Participation: The MSDH strongly encourages all nursing homes
                  participating in the Medicaid program to also become certified for participation in the
                  Medicare program.

           8.     Alzheimer’s/Dementia Care Unit: The MSDH encourages all nursing home owners to
                  consider the establishment of an Alzheimer’s/Dementia Care Unit as an integral part of
                  their nursing care program.


  104.02        Certificate of Need Criteria and Standards for Nursing Home Care Beds

      If the legislative moratorium were removed or partially lifted, the MSDH would review
      applications for the offering of nursing home care under the statutory requirements of Sections
      41-7-173 (h) subparagraphs (iv) and (vi), 41-7-191, and 41-7-193, Mississippi Code of 1972,
      as amended. The MSDH will also review applications for Certificate of Need according to the
      applicable policy statements contained in this Plan; the general criteria listed in the Mississippi
      Certificate of Need Review Manual; all adopted rules, procedures, and plans of the MSDH; and
      the specific criteria and standards listed below.




Chapter 2 – Long-Term Care                             8                             2011 State Health Plan
      Certificate of Need review is required for the offering of nursing home care services, as
      defined, if the capital expenditure exceeds $2,000,000; if the licensed bed capacity is increased
      through the conversion or addition of beds; or if nursing home care services have not been
      provided on a regular basis by the proposed provider of such services within the period of
      twelve (12) months prior to the time such services would be offered. Certificate of Need review
      is required for the construction, development, or otherwise establishment of new nursing home
      care beds regardless of capital expenditure.

           1.     Need Criterion: The applicant shall document a need for nursing home care beds
                  using the need methodology as presented herein: The Long-Term Care Planning
                  District wherein the proposed facility will be located must show a need using the
                  following ratio:

                     0.5 beds per 1,000 population aged 64 and under
                     10 beds per 1,000 population aged 65-74
                     36 beds per 1,000 population aged 75-84
                     135 beds per 1,000 population aged 85 and older

           2.     The applicant shall document the number of beds that will be constructed, converted,
                  and/or licensed as offering nursing home care services.

           3.     The MSDH should consider the area of statistical need as one criterion when awarding
                  Certificates of Need in the case of competing applications.

           4.     Any applicant applying for nursing home beds who proposes to establish an
                  Alzheimer’s/Dementia Care Unit shall affirm that the applicant shall fully comply with
                  all licensure regulations of the MSDH for said Alzheimer’s/Dementia Care Unit.


  104.03        Certificate of Need Criteria and Standards for Nursing Home Beds As Part of a
                Continuing Care Retirement Community (CCRC)

      Entities desiring to establish nursing home beds as part of a CCRC shall meet all applicable
      requirements, as determined by the MSDH, of the policy statements and general CON criteria
      and standards in the Mississippi Certificate of Need Review Manual and the CON criteria and
      standards for nursing home beds established in this State Health Plan.




2011 State Health Plan                                9                      Chapter 2 – Long-Term Care
                                        Map 2-1
                             Long-Term Care Planning Districts




Chapter 2 – Long-Term Care                   10                  2011 State Health Plan
2011 State Health Plan




                                                                                                       Table 2-3
                                                                                        2015 Projected Nursing Home Bed Need1
                                                                                                State of Mississippi
                                  Long-Term
                                 Care Planning Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed Beds in Licensed/CON
                                    District     0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84 (36/1,000)         85+ (135/1,000) Need Abeyance Approved Beds Difference

                             District I             566,077        283        44,535      445      28,730       1,034     15,269         2,061     3,824       130    3,239 / 60             395
                             District II            599,374        300        52,002      520      36,519       1,315     19,672         2,656     4,790        28    4,106 0                656
                             District III           817,732        409        66,428      664      43,179       1,554     23,215         3,134     5,762        57    4,644 0              1,061
                             District IV          1,048,431        524        89,546      895      60,526       2,179     31,875         4,303     7,902       310    5,392 / 240          1,960

                             State Total          3,031,614       1,516      252,511     2,525    168,954       6,082     90,031        12,154    22,277       525 17,381 / 300            4,071

                             1
                                 Data may not equal totals due to rounding

                                 Note: Licensed beds do not include 694 beds operated by the Department of Mental Health, 120 beds operated by the Mississippi Band of Choctaw Indians, 600
                                 beds operated by the Mississippi Veteran’s Affairs Board, 60 beds operated by the Mississippi Methodist Rehabilitation Center for the treatment of patients with
11




                                 special disabilities, including persons with spinal cord and closed-head injuries and ventilator-dependent patients, or 284 beds licensed to continuing care
                                 retirement communities (CCRC).

                                 Sources: Mississippi State Department of Health, Division of Licensure and Certification; and Division of Health Planning and Resource Development
                                 Calculations, 2010

                                 Population Projections: Mississippi Population Projections 2010, 2015, and 2020. Center for Policy Research and Planning, Mississippi Institutions of Higher
                                 Learning, August 2005
Chapter 2 – Long-Term Care
                                                                                                          Table 2-3 (continued)
                   2011 State Health Plan
– Long-Term Care




                                                                                                 2015 Projected Nursing Home Bed Need

                                                                                                                     District I

                                                                Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed # Beds in Licensed/CON
                                                  County          0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84  (36/1,000)  85+     (135/1,000) Need   Abeyance Approved Beds Difference

                                               Attala              19,806      9.90      1,861    18.61      1,485       53.46       881    118.94     201        0     120               81
                                               Bolivar             37,625     18.81      3,071    30.71      1,803       64.91     1,023    138.11     253       60     350   0         -157
                                               Carroll             10,636      5.32      1,169    11.69        751       27.04       374     50.49      95        0      60   0           35
                                               Coahoma             28,368     14.18      2,149    21.49      1,589       57.20       897    121.10     214        8     178   0           28

                                               DeSoto             163,041     81.52     12,356   123.56      6,435      231.66     2,974    401.49     838        0     320   0         518
                                               Grenada             23,431     11.72      2,078    20.78      1,516       54.58       857    115.70     203        0     257   0         -54
                                               Holmes              21,211     10.61      1,400    14.00      1,128       40.61       607     81.95     147        0     148   0          -1
                                               Humphreys           11,827      5.91        802     8.02        597       21.49       329     44.42      80        0      60   0          20

                                               Leflore             34,712     17.36      2,422    24.22      1,707       61.45       971    131.09     234        0     410   0         -176
                   12




                                               Montgomery          11,377      5.69      1,088    10.88        866       31.18       522     70.47     118        0     120   0           -2
                                               Panola              37,504     18.75      3,036    30.36      2,057       74.05     1,101    148.64     272        0     190               82
                                               Quitman             10,631      5.32        766     7.66        608       21.89       331     44.69      80        0      60   0           20

                                               Sunflower           33,536     16.77      2,006    20.06      1,332       47.95      731      98.69     183        2     242 0            -61
                                               Tallahatchie        13,923      6.96      1,231    12.31        905       32.58      496      66.96     119        0      68 / 60          -9
                                               Tate                29,029     14.51      2,506    25.06      1,574       56.66      796     107.46     204        0     120 0             84
                                               Tunica              10,806      5.40        851     8.51        472       16.99      237      32.00      63        0      60 0              3

                                               Washington          55,541     27.77      4,493    44.93      2,938      105.77     1,625    219.38     398       58     356              -16
                   Chapter 2– Long-Term Care




                                               Yalobusha           13,073      6.54      1,250    12.50        967       34.81       517     69.80     124        2     120                2

                                               District Total     566,077    283.04     44,535   445.35     28,730    1,034.28    15,269   2,061.32   3,824     130   3,239 / 60        395
                                                                                           Table 2-3 (continued)
                                                                                  2015 Projected Nursing Home Bed Need
2011 State Health Plan




                                                                                                    District II

                                              Population Bed Need Population Bed Need Population Bed Need Population Bed Need         Total Bed    # Beds in       Licensed/CON
                                 County         0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84 (36/1,000)   85+     (135/1,000)        Need       Abeyance        Approved Beds   Difference

                             Alcorn               35,080     17.54      3,741     37.41     2,568      92.45       1,387    187.25          335                0       264    0            71
                             Benton                7,365      3.68        693      6.93       566      20.38         307     41.45           72                0        60    0            12
                             Calhoun              13,327      6.66      1,398     13.98     1,086      39.10         642     86.67          146                0       155    0            -9
                             Chickasaw            17,416      8.71      1,550     15.50     1,195      43.02         638     86.13          153                0       139    0            14

                             Choctaw               9,831      4.92        923      9.23       697      25.09         382     51.57           91           13            73    0             5
                             Clay                 21,102     10.55      1,760     17.60     1,280      46.08         714     96.39          171            0           180    0            -9
                             Itawamba             25,114     12.56      2,361     23.61     1,705      61.38         893    120.56          218            0           196    0            22
                             Lafayette            45,034     22.52      2,942     29.42     2,036      73.30       1,098    148.23          273            0           180    0            93

                             Lee                  78,022     39.01      6,877     68.77     4,499     161.96       2,319    313.07          583                0       487    0            96
                             Lowndes              58,406     29.20      4,955     49.55     3,200     115.20       1,743    235.31          429                0       380    0            49
13




                             Marshall             37,928     18.96      3,246     32.46     1,980      71.28       1,011    136.49          259                0       180                 79
                             Monroe               37,972     18.99      3,595     35.95     2,615      94.14       1,401    189.14          338                0       332    0             6

                             Noxubee              11,243      5.62        915      9.15       646      23.26        353      47.66           86                0        60    0            26
                             Oktibbeha            45,742     22.87      2,887     28.87     1,840      66.24        977     131.90          250                0       179    0            71
                             Pontotoc             30,374     15.19      2,554     25.54     1,738      62.57        963     130.01          233                0       164    0            69
                             Prentiss             27,509     13.75      2,497     24.97     1,807      65.05        968     130.68          234                0       144    0            90

                                                  21,817
Chapter 2 – Long-Term Care




                             Tippah                          10.91      1,958     19.58     1,513      54.47        813     109.76          195            0           240    0            -45
                             Tishomingo           18,970      9.49      2,040     20.40     1,610      57.96        873     117.86          206           15           178    0             13
                             Union                27,809     13.90      2,455     24.55     1,797      64.69        982     132.57          236            0           180                  56
                             Webster               9,671      4.84        889      8.89       751      27.04        424      57.24           98            0           155    0            -57

                             Winston              19,642      9.82      1,766     17.66     1,390      50.04         784     105.84          183           0            180   0             3
                             District Total      599,374    299.69     52,002    520.02    36,519   1,314.68      19,672   2,655.72        4,790          28          4,106   0           656
                                                                                                 Table 2-3 (continued)
                                                                                          2015 Projected Nursing Home Bed Need
                2011 State Health Plan




                                                                                                              District III

                                                          Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed # Beds in Licensed/CON
                                            County          0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84  (36/1,000)  85+     (135/1,000) Need   Abeyance Approved Beds Difference

                                         Adams                29,216     14.61    2,982     29.82     2,348        84.53      1,313    177.26     306     20       254   0         32
                                         Amite                13,316      6.66    1,343     13.43       980        35.28        520     70.20     126      0        80   0         46
                                         Claiborne            12,593      6.30      765      7.65       571        20.56        301     40.64      75      0        77   0         -2
                                         Copiah               31,112     15.56    2,495     24.95     1,713        61.67        946    127.71     230      0       180   0         50

                                         Franklin              8,507      4.25      724      7.24       605        21.78        336     45.36       79     0        60   0         19
                                         Hinds               234,163    117.08   18,332    183.32    11,805       424.98      6,540    882.90    1,608     6     1,427   0        175
                                         Issaquena             2,549      1.27      173      1.73       139         5.00         64      8.64       17     0         0   0         17
                                         Jefferson             9,270      4.64      641      6.41       498        17.93        260     35.10       64     0        60   0          4
14




                                         Lawrence             14,336      7.17    1,191     11.91       940        33.84        473     63.86     117      0        60   0         57
                14




                                         Lincoln              35,507     17.75    3,178     31.78     2,217        79.81      1,270    171.45     301      0       320   0        -19
                                         Madison              95,178     47.59    6,625     66.25     3,790       136.44      2,061    278.24     529      0       395   0        134
                                         Pike                 41,309     20.65    3,466     34.66     2,531        91.12      1,431    193.19     340      0       285   0         55

                                         Rankin              153,571     76.79   12,868    128.68     6,990       251.64      3,337    450.50     908      0       350   0        558
                                         Sharkey               5,573      2.79      488      4.88       312        11.23        174     23.49      42      0        54   0        -12
Chapter 8 – Long-Term Care




                                         Simpson              29,378     14.69    2,554     25.54     1,797        64.69        959    129.47     234      0       180   0         54
                                         Walthall             14,984      7.49    1,383     13.83     1,016        36.58        532     71.82     130      0       137   0         -7
     Chapter 2 – Long-Term Care




                                         Warren               46,866     23.43    4,314     43.14     2,724        98.06      1,450    195.75     360     31       380   0         -51
                                         Wilkinson            10,323      5.16      791      7.91       625        22.50        352     47.52      83      0       105   0         -22
                                         Yazoo                29,981     14.99    2,115     21.15     1,578        56.81        896    120.96     214      0       240   0         -26

                                         District Total     817,732     408.87   66,428    664.28    43,179     1,554.44     23,215   3,134.03   5,762    57     4,644   0       1,061
                                                                                          Table 2-3 (continued)
                                                                                 2015 Projected Nursing Home Bed Need
2011 State Health Plan




                                                                                                   District IV

                                              Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed # Beds in Licensed/CON
                                 County         0 - 64   (0.5/1,000)  65 - 74 (10/1,000) 75 - 84   (36/1,000) 85+     (135/1,000) Need    Abeyance Approved Beds Difference
                             Clarke               16,814         8.41     1,641    16.41     1,229      44.24     678       91.53     161         0  120 0                41
                             Covington            21,261       10.63      1,759    17.59     1,292      46.51     675       91.13     166         0   60 / 60             46
                             Forrest              81,120       40.56      5,776    57.76     3,854     138.74   2,222      299.97     537       93   486 0               -42
                             George               22,823       11.41      2,010    20.10     1,196      43.06     575       77.63     152         0   60 / 60             32

                             Greene              16,558       8.28     1,181     11.81       732       26.35        372     50.22       97        0   120   0            -23
                             Hancock             51,805      25.90     5,383     53.83     3,474      125.06      1,722    232.47      437       29   169                239
                             Harrison           200,028     100.01    16,375    163.75    10,732      386.35      5,566    751.41    1,402      120   796                486
                             Jackson            145,132      72.57    12,751    127.51     7,711      277.60      3,694    498.69      976        0   528   0            448
                             Jasper               19,113      9.56     1,617     16.17     1,198       43.13        648     87.48     156         0   110   0             46
                             Jeff Davis           13,519      6.76     1,270     12.70       900       32.40        489     66.02     118         0    60   0             58
                             Jones                67,365     33.68     5,922     59.22     4,426      159.34      2,439    329.27     582        10   428   0            144
                             Kemper               11,229      5.61       905      9.05       723       26.03        398     53.73      94              60   0             34
15




                             Lamar                49,737     24.87     3,720     37.20     2,265       81.54      1,141    154.04     298         3   150                145
                             Lauderdale           77,262     38.63     6,569     65.69     4,989      179.60      2,865    386.78     671        52   540   0             79
                             Leake                22,202     11.10     1,914     19.14     1,417       51.01        806    108.81     190         0   143   0             47
                             Marion               25,396     12.70     2,195     21.95     1,627       58.57        946    127.71     221         0   297   0            -76

                             Neshoba              31,230     15.62     2,602     26.02     1,941       69.88      1,096    147.96     259         3   220                 36
                             Newton               22,479     11.24     1,954     19.54     1,520       54.72        852    115.02     201         0   180                 21
                             Pearl River          57,371     28.69     5,559     55.59     3,535      127.26      1,770    238.95     450         0   246 / 120           84
                             Perry                13,402      6.70     1,157     11.57       766       27.58        368     49.68      96         0    60 0               36
Chapter 2 – Long-Term Care




                             Scott                29,252     14.63     2,489     24.89     1,724       62.06       903     121.91     223         0   140   0             83
                             Smith                15,336      7.67     1,493     14.93     1,113       40.07       583      78.71     141         0   121   0             20
                             Stone                16,277      8.14     1,425     14.25       885       31.86       425      57.38     112         0   208   0            -96
                             Wayne                21,720     10.86     1,879     18.79     1,277       45.97       642      86.67     162         0    90   0             72

                             District Total    1,048,431    524.22    89,546    895.46    60,526     2,178.94    31,875   4,303.13   7,902      310 5,392 / 240        1,960
105 Policy Statement Regarding Certificate of Need Applications for a Pediatric
    Skilled Nursing Facility

      1.     The 1993 Mississippi Legislature authorized the Department of Health to issue a
             Certificate of Need for the construction of a pediatric skilled nursing facility not to exceed
             60 new beds.

      2.     A pediatric skilled nursing facility is defined as an institution or a distinct part of an
             institution that is primarily engaged in providing to inpatients skilled nursing care and
             related services for persons under 21 years of age who require medical, nursing care, or
             rehabilitation services for the rehabilitation of injured, disabled, or sick persons.

      3.     The MSDH will review applications for the construction of pediatric skilled nursing
             facility beds using the general CON review criteria and standards contained in the
             Mississippi Certificate of Need Review Manual, criteria and standards for nursing homes
             and MR/DD facilities contained in the State Health Plan, and all adopted rules,
             procedures, and plans of the Mississippi State Department of Health.

      4.     Effective April 12, 2002, no health care facility shall be authorized to add any beds or
             convert any beds to another category of beds without a Certificate of Need under the
             authority of Section 41-7-191(1)(c).

      5.     Effective March 4, 2003, if a health care facility has voluntarily delicensed some of its
             existing bed complement, it may later relicense some or all of its delicensed beds without
             the necessity of having to acquire a Certificate of Need. The Department of Health shall
             maintain a record of the delicensing health care facility and its voluntarily delicensed beds
             and continue counting those beds as part of the state’s total bed count for health care
             planning purposes.


106 Certificate of Need Criteria and Standards for Nursing Home Care Services for
    Mentally Retarded and other Developmentally Disabled Individuals


  106.01        Policy Statement Regarding Certificate of Need Applications for the Offering of
                Nursing Home Care Services for Mentally Retarded and Other Developmentally
                Disabled Individuals

           1.     Legislation

                   a. The 1990 Mississippi Legislature imposed a permanent moratorium which
                      prohibits the MSDH from granting approval for or issuing a CON to any person
                      proposing the new construction, addition to, or expansion of an intermediate care
                      facility for the mentally retarded (ICF/MR).

                   b. Effective July 1, 1990, any health care facility defined as a psychiatric hospital,
                      skilled nursing facility, intermediate care facility, intermediate care facility for the
                      mentally retarded, or psychiatric residential treatment facility which is owned by
                      the State of Mississippi and under the direction and control of the State
                      Department of Mental Health is exempted from the requirement of the issuance of


2011 State Health Plan                                   16                       Chapter 2 – Long-Term Care
                      a Certificate of Need under Section 41-7-171 et seq., for projects which involve
                      new construction, renovation, expansion, addition of new beds, or conversion of
                      beds from one category to another in any such defined health care facility.

                   c. Effective April 12, 2002, no health care facility shall be authorized to add any beds
                      or convert any beds to another category of beds without a Certificate of Need.

                   d. Effective March 4, 2003, if a health care facility has voluntarily delicensed some
                      of its existing bed complement, it may later relicense some or all of its delicensed
                      beds without the necessity of having to acquire a Certificate of Need. The
                      Department of Health shall maintain a record of the delicensing health care facility
                      and its voluntarily delicensed beds and continue counting those beds as part of the
                      state’s total bed count for health care planning purposes.

           2.     MR/DD Long-Term Care Planning Districts (MR/DD LTCPD): The need for
                  additional MR/DD nursing home care beds shall be based on the MR/DD LTCPDs as
                  outlined on Map 2-2.

           3.     Bed Need: The need for MR/DD nursing home care beds is established at one bed per
                  1,000 population less than 65 years of age.

           4.     Population Projections: The MSDH shall use population projections as presented in
                  Table 2-4 when calculating bed need.

           5.     Bed Limit: No MR/DD LTCPD shall be approved for more than its proportioned share
                  of needed MR/DD nursing home care beds. No application shall be approved which
                  would over-bed the state as a whole.

           6.     Bed Inventory: The MSDH shall review the need for additional MR/DD nursing home
                  care beds utilizing the most recent information available regarding the inventory of
                  such beds.


  106.02        Certificate of Need Criteria and Standards for Nursing Home Beds for Mentally
                Retarded and Other Developmentally Disabled Individuals

      If the legislative moratorium were removed or partially lifted, the Mississippi State Department
      of Health would review applications for MR/DD nursing home care beds under the statutory
      requirements of Sections 41-7-173 (h) subparagraph (viii), 41-7-191, and 41-7-193, Mississippi
      Code 1972, as amended. The MSDH will also review applications for Certificate of Need
      according to the applicable policy statements contained in this Plan; the general criteria as
      listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and
      plans of the Mississippi State Department of Health; and the specific criteria and standards
      listed below.

      Certificate of Need review is required for the offering of MR/DD nursing home care services,
      as defined, if the capital expenditure exceeds $2,000,000; if the licensed bed capacity is
      increased through the conversion or addition of beds; or if MR/DD nursing home care services
      have not been provided on a regular basis by the proposed provider of such services within the
      period of twelve (12) months prior to the time such services would be offered. Certificate of


2011 State Health Plan                                 17                      Chapter 2 – Long-Term Care
      Need review is required for the construction, development, or otherwise establishment of new
      MR/DD nursing home care beds regardless of capital expenditure.

          1.   Need Criterion: The applicant shall document a need for MR/DD nursing home
               care beds using the need methodology as presented below. The applicant shall
               document in the application the following:

                a. using the ratio of one bed per 1,000 population under 65 years of age, the state
                   as a whole must show a need; and

                b. the MR/DD Long-Term Care Planning District (LTCPD) where the proposed
                   facility/beds/services are to be located must show a need.

          2.   The applicant shall document the number of beds that will be constructed/converted
               and/or licensed as offering MR/DD nursing home care services.

          3.   The MSDH shall give priority consideration to those CON applications proposing the
               offering of MR/DD nursing home care services in facilities which are 15 beds or less in
               size.




2011 State Health Plan                             18                     Chapter 2 – Long-Term Care
                                            Map 2-2
                  Mentally Retarded/Developmentally Disabled Long-Term Care
                      Planning Districts and Location of Existing Facilities
                                     (ICF/MR – Licensed)




2011 State Health Plan                         19                  Chapter 2 – Long-Term Care
                                                        Table 2-4
                                     2010 Projected MR/DD Nursing Home Bed Need
                                     (1 Bed per 1,000 Population Aged 65 and Under)
                                           2010                    Projected
                                                    2008 Licensed                                  1
                                         Projected                MR/DD Bed           Difference
                                                        Beds
                                         Pop. <65                   Need 1
            Mississippi                   2,533,613        2,765        2,534                -231
            District I                      619,374           623            619                -4

            Alcorn                            28,263            0             28               28
            Benton                             6,104            0              6                6
            Calhoun                           10,976            0             11               11
            Chickasaw                         14,767            0             15               15

            Coahoma                          24,773           132             25             -107
            DeSoto                          131,632             0            132              132
            Grenada                          19,177             0             19               19
            Itawamba                         19,678             0             20               20

            Lafayette                         37,712          491             38             -453
            Lee                               65,953            0             66               66
            Marshall                          31,792            0             32               32
            Monroe                            31,043            0             31               31

            Panola                            31,246            0             31               31
            Pontotoc                          24,883            0             25               25
            Prentiss                          22,421            0             22               22
            Quitman                            8,828            0              9                9

            Tallahatchie                      11,685            0             12               12
            Tate                              23,888            0             24               24
            Tippah                            17,657            0             18               18
            Tishomingo                        14,840            0             15               15

            Tunica                             9,015            0              9                9
            Union                             22,578            0             23               23
            Yalobusha                         10,463            0             10               10


        1
            Data may not equal totals due to rounding.




2011 State Health Plan                                   20              Chapter 2 – Long-Term Care
                                               Table 2-4 (continued)
                                 2010 Projected MR/DD Nursing Home Bed Need
                                 (1 Bed per 1,000 Population Aged 65 and Under)
                                      2010                   Projected
                                              2008 Licensed
                                    Projected               MR/DD Bed             Difference 1
                                                  Beds              1
                                    Pop. <65                  Need
        District II                   855,700          707          856                   149

        Attala                            15,757            0             16               16
        Bolivar                           33,131            0             33               33
        Carroll                            8,707            0              9                9
        Choctaw                            8,020            0              8                8

        Clay                             17,957             0             18               18
        Hinds                           206,884             0            207              207
        Holmes                           17,918             0             18               18
        Humphreys                         9,988             0             10               10

        Issaquena                          2,115            0              2                2
        Leake                             18,272            0             18               18
        Leflore                           30,809            0             31               31
        Lowndes                           50,618            0             51               51

        Madison                          79,717           152             80              -72
        Montgomery                        9,271             0              9                9
        Oktibbeha                        40,040           140             40             -100
        Rankin                          124,530           415            125             -290

        Scott                             24,516            0             25               25
        Sharkey                            4,986            0              5                5
        Sunflower                         29,947            0             30               30
        Warren                            40,133            0             40               40

        Washington                        49,559            0             50               50
        Webster                            7,909            0              8                8
        Yazoo                             24,916            0             25               25

    1
        Data may not equal totals due to rounding.




2011 State Health Plan                               21                  Chapter 2 – Long-Term Care
                                          Table 2-4 (continued)
                            2010 Projected MR/DD Nursing Home Bed Need
                            (1 Bed per 1,000 Population Aged 65 and Under)
                                      2010              2008       Projected
                                    Projected         Licensed    MR/DD Bed     Difference 1
                                                                          1
                                    Pop. <65            Beds        Need
         District III                 650,057            1,175           650           -525

         Adams                           24,387              0          24               24
         Amite                           10,711              0          11               11
         Claiborne                       10,816              0          11               11
         Clarke                          13,892              0          14               14

         Copiah                          25,962              0          26               26
         Covington                       17,250              0          17               17
         Forrest                         68,607              0          69               69
         Franklin                         6,928              0           7                7

         Greene                          13,642              0          14               14
         Jasper                          15,576              0          16               16
         Jefferson                        8,027              0           8                8
         Jefferson Davis                 11,157              0          11               11

         Jones                           55,684             712         56             -656
         Kemper                           9,192               0          9                9
         Lamar                           41,083               0         41               41
         Lauderdale                      64,102               0         64               64

         Lawrence                        11,621               0         12               12
         Lincoln                         29,112             140         29             -111
         Marion                          21,271               0         21               21
         Neshoba                         25,437               0         25               25

         Newton                          18,404              0          18               18
         Noxubee                          9,795              0          10               10
         Perry                           11,105              0          11               11
         Pike                            34,056              0          34               34

         Simpson                         24,215             323         24             -299
         Smith                           12,632               0         13               13
         Walthall                        12,317               0         12               12
         Wayne                           18,212               0         18               18

         Wilkinson                        8,619              0           9                9
         Winston                         16,245              0          16               16

     1
         Data may not equal totals due to rounding.



2011 State Health Plan                                 22                Chapter 2 – Long-Term Care
                                           Table 2-4 (continued)
                             2010 Projected MR/DD Nursing Home Bed Need
                             (1 Bed per 1,000 Population aged 65 and Under)
                                       2010                   Projected
                                               2008 Licensed
                                     Projected               MR/DD Bed Difference 1
                                                   Beds
                                     Pop. <65                  Need 1
         District IV                   408,482          260          408      148

         George                           18,445             0            18             18
         Hancock                          40,615             0            41             41
         Harrison                        169,196           260           169            -91
         Jackson                         120,720             0           121            121

         Pearl River                      46,173            0             46              46
         Stone                            13,333            0             13              13

     1
         Data may not equal totals due to rounding.




2011 State Health Plan                                23                 Chapter 2 – Long-Term Care
  CHAPTER 3
MENTAL HEALTH
.
Chapter 03 Mental Health
This chapter addresses mental illness, alcoholism, drug abuse, and developmental disabilities. These
conditions result in social problems of such magnitude that mental health ranks as one of the state's
priority health issues. The Mississippi Department of Mental Health, regional community Mental
Health-Mental Retardation Centers, and licensed private sector facilities provide most of the state's
mental health services. Unless otherwise specified, information in this chapter is limited to the
programs and services of private non-governmental entities.


100 Mississippi Department of Mental Health

   State law designates the Mississippi Department of Mental Health (MDMH) as the agency to
   coordinate and administer the delivery of public mental health services, alcohol/drug abuse
   services, and services for persons with intellectual/developmental disabilities throughout the state,
   as well as community-based day programs for individuals with Alzheimer’s disease and other
   dementia. Responsibilities of MDMH include: (a) state-level planning and expansion of all types
   of mental health, mental retardation, and substance abuse services, (b) standard-setting and
   support for community mental health/mental retardation and alcohol/drug abuse programs, (c)
   state liaison with mental health training and educational institutions, (d) operation of the state's
   psychiatric facilities, and (e) operation of the state's facilities for individuals with
   intellectual/developmental disabilities.

   Regional community mental health-mental retardation centers provide a major component of the
   state's mental health services. Fifteen centers currently operate in the state's mental health service
   areas, and most centers have satellite offices in other counties. Each center must meet federal and
   state program and performance standards. The major objectives of the regional community mental
   health centers include: (a) providing accessible services to all citizens with mental and emotional
   problems; (b) reducing the number of initial admissions to the state hospitals; and (c) preventing
   re-admissions through supportive aftercare services. These centers are a vital element in the plan
   to provide an integrated system of mental health services to all residents of Mississippi.


101 Mental Health Needs in Mississippi

   The prevalence of mental illness, although difficult to assess, serves as a good indicator of the
   volume of need for mental health services in a given population. The negative social stigma
   associated with the term "mental illness" also obstructs efforts to measure the true incidence/
   prevalence of most types of mental illness and behavior disorders and the need for mental health
   services.

   Using the methodology updated by the federal Center for Mental Health Services (CMHS) for
   estimated prevalence of serious mental illness among adults (Federal Register, June 24, 1999) and
   U.S. Bureau of the Census 2008 population estimates, the MDMH estimates the prevalence of
   serious mental illness among adults in Mississippi, ages 18 years and above, as 5.4 percent or
   116,414 individuals. The same methodology estimates the national prevalence for the same age
   group also as 5.4 percent.

   In Fiscal Year 2009, a total of 67,611 adults received mental health services through the public
   community mental health system, including the regional community mental health centers and the
   state psychiatric hospitals. (Note: Totals might include some duplication across community and


2011 State Health Plan                               1                         Chapter 3 – Mental Health
   hospital services.) A total of 53,910 adults with a serious mental illness were served through the
   public community mental health system, including the community mental health centers,
   Community Services Divisions of Mississippi State Hospital, and East Mississippi State Hospital,
   and group homes operated by Central MS Residential Center.


   101.01     Mental Health Needs of Children/Adolescents

      Precise data concerning the size of the country's population of children and adolescents with
      emotional or mental disorders remain difficult to obtain. The methodology issued by the
      national Center of Mental Health Services (Federal Register, July 17,1998) estimates the
      prevalence of serious emotional disturbance nationally among children and adolescents (9-17
      years of age) to be between 9-13 percent. The methodology adjusts for socio-economic
      differences across states. Given Mississippi’s relatively high poverty rate when compared to
      other states, the estimated prevalence ranges for the state, updated based on 2008 Census data,
      were on the highest end of the range, as follows:

         1.    Mississippi’s estimated prevalence of serious emotional disturbance in children and
               adolescents (ages 9 to 17) is between 11 and 13 percent, or 41,663 – 49,238 children.

         2.    Mississippi’s estimated prevalence of the more severely impaired group of children
               and adolescents (estimated at five to nine percent of the national population), aged 9-
               17 is between seven and nine percent, or 26,513 – 34,088 Mississippi children.

         3.    The MDMH estimates that the prevalence of serious emotional disturbance among
               Mississippi youth in the transition age group of 18 to 21 years of age is estimated to be
               12,300.

      Note: As pointed out in the methodology, there are limitations to these estimated prevalence
      ranges, including the “modest” size of the studies from which these estimates were derived;
      variation in the population, instruments, methodology, and diagnostic systems across the
      studies; inadequate data on which to base estimates of prevalence for children under nine; and
      inadequate data from which to determine potential differences related to race or ethnicity or
      whether or not the youth lived in urban or rural areas.

      In Fiscal Year 2009, the public community mental health system served 30,199 children and
      adolescents with serious emotional disturbance. (Note: Totals might include some duplication
      across community mental health centers and other nonprofit programs


   101.02     National Survey on Drug Use and Health for Mississippi

      According to statistics cited in SAMHSA’s 2007-08 National Survey on Drug Use and Health
      state estimates, seven percent of Mississippians 12 years or older were past-month illicit drug
      users. Past-month marijuana use among Mississippians 12 years and older was four percent.
      Approximately 38.4 percent of Mississippians were past-month alcohol users. Past month binge
      alcohol use among Mississippians was 19.87 percent.




Chapter 3 – Mental Health                            2                            2011 State Health Plan
101.03 Developmental Disabilities

   The nationally-accepted prevalence rate estimate used by the Federal Administration on
   Developmental Disabilities for estimating the state rate is 1.8 percent of the general population. By
   applying the 1.8 percent prevalence rate to Mississippi's 2010 population projections, the results
   equal 53,560 individuals who may have a developmental disability. The intellectual and/or
   developmental disability bed need determinations can be found in Chapter 8 of this Plan.


102 Adult Psychiatric Services (State-Operated and Private)

   Mississippi's four state-operated hospitals and seven crisis centers provide the majority of
   inpatient psychiatric care and services throughout the state. In FY 2009, the Mississippi State
   Hospital at Whitfield reported a total of 472 active psychiatric licensed beds; East Mississippi
   State Hospital at Meridian reported 253 active psychiatric licensed beds, North Mississippi State
   Hospital in Tupelo reported 50 active licensed beds, and South Mississippi State Hospital in
   Purvis reported 50 licensed beds. The four facilities reported that 3,921 adults received psychiatric
   services at the hospitals in FY 2009 —1,971 at Mississippi State Hospital at Whitfield, 1,138 at
   East Mississippi State Hospital, 380 at North Mississippi State Hospital, and 432 at South
   Mississippi State Hospital. Additionally, a total of 1,414 adults were served through the seven
   crisis centers in FY 2009.

   Even though many private facilities have low occupancy rates, the state institutions provide the
   majority of inpatient care for the medically indigent. Medically indigent patients have difficulty
   gaining access to private psychiatric facilities in their respective communities. To help address the
   problem, the Legislature provided funding for seven state crisis intervention centers as satellites to
   existing facilities operated by the Department of Mental Health (DMH). Centers are operational
   in Brookhaven, Corinth, Newton, Laurel, Cleveland, and Batesville. The Department of Mental
   Health contracted with Life Help (Region VI community mental health center) to operate the crisis
   center in Grenada beginning September 1, 2009. This pilot program began with the purpose of
   studying the potential for increased efficiencies and improved access to services by individuals
   without their being involuntarily committed.

   All of the centers include 16 beds and one isolation bed. The role of these centers in the regional
   system is to provide stabilization and treatment services to persons who have been committed to a
   psychiatric hospital and for whom a bed is not available.

   Mississippi has 14 hospital-based and two freestanding adult psychiatric facilities, with a capacity
   of 535 licensed beds for adult psychiatric patients (plus 7 held in abeyance by the MSDH and 34
   CON approved) distributed throughout the state. The criteria and standards section of this chapter
   provides a full description of the services that private facilities must provide. Map 3-1 shows the
   location of inpatient facilities in Mississippi serving adult acute psychiatric patients; Table 3-2
   shows utilization statistics.




2011 State Health Plan                               3                         Chapter 3 – Mental Health
                                                       Table 3-1
                                         Acute Adult Psychiatric Bed Utilization
                                                       FY 2009

                                                                              a
                                                              Licensed/CON /          Inpatient Occupancy
      Facility                                   County       Abeyanceb Beds            Days     Rate (%)       ALOS
       Alliance Health Center                    Lauderdale      36          0          13,983       106.42      10.98
       Baptist Memo. Hospital-Golden Triangle    Lowndes         22          0           3,841         47.83      6.98
       Biloxi Regional Medical Center            Harrison        34                      6,985         56.29      7.58
                                                                             b
       Brentwood Behavioral Health Care *        Rankin          48         2            6,118         34.92      8.76
       Central Miss Medical Center               Hinds           29          0           7,090         66.98      5.07
       Delta Regional Medical Center- West       Washington       9                      2,055         62.56      5.36
       Forrest General Hospital                  Forrest         40       24a           11,322         77.55      6.47
       Magnolia Regional Health Center           Alcorn          19          0           4,108         59.24      7.91
       Memorial Hospital at Gulfport             Harrison        59          0           4,681         21.74      8.09
       North Miss Medical Center                 Lee             33          0           9,972         82.79      5.99
       Parkwood Behavioral Health System         DeSoto          22          0           9,460       117.81       9.48
       River Region Health System                Warren          40          0           6,717         46.01      8.97
       Singing River Hospital                    Jackson         30          0           5,393         49.25      5.58
       St. Dominic Hospital                      Hinds           83          0          10,433         34.44      4.81
       Tri-Lakes Medical Center *                Panola          10     10a/5b           3,434         94.08      8.49
       University Hospital & Clinics             Hinds           21          0           6,036         78.75      6.71

                                                                          a       b
          Total Adult Psychiatric Beds                          535     34 /7         111,628           57.16      6.99

      a
       CON approved
      b
        Beds held in abeyance by the MSDH
      *Tri-Lakes Medical Center leases 25 beds from Brentwood Behavioral Health Center. Five beds
      remained in abeyance until December 2009 and 10 beds were CON approved July 2010. Brentwood has
      a balance of two beds in abeyance.

      Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
      Hospital Report; and Division of Health Planning and Resource Development Computations




Chapter 3 – Mental Health                                4                                      2011 State Health Plan
                                         Map 3-1
                         Operational and Proposed Inpatient Facilities
                          Serving Adult Acute Psychiatric Patients*




2011 State Health Plan                        5                      Chapter 3 – Mental Health
103 Child/Adolescent Psychiatric Services

   Three private and five hospital-based facilities, with a total of 222 licensed beds, provide acute
   psychiatric inpatient services for children and adolescents. An additional 20 acute adolescent
   psychiatric beds are CON approved. Map 3-2 shows the location of inpatient facilities that serve
   adolescent acute psychiatric patients; Table 3-2 gives utilization statistics. The criteria and
   standards section of this chapter provides a further description of the programs that inpatient
   facilities offering child/adolescent psychiatric services must provide. The Mississippi State
   Legislature has placed a moratorium on the approval of new Medicaid-certified child/adolescent
   beds within the state.

   The Department of Mental Health operates a separately-licensed 60-bed facility (Oak Circle
   Center) at Mississippi State Hospital to provide short-term inpatient psychiatric treatment for
   children and adolescents between the ages of four and 17. East Mississippi State Hospital operates
   a 50-bed psychiatric and chemical dependency treatment unit for adolescent males.

                                                Table 3-2
                                Acute Adolescent Psychiatric Bed Utilization
                                                 FY 2009


                                                                     a
                                                        Licensed/CON /    Inpatient    Occupancy
                                                                 b
   Facility                                County       Abeyance Beds       Days        Rate(%)  ALOS
       Alliance Health Center              Lauderdale       22       0      14,166       176.41      23.27
       Biloxi Regional Medical Center *    Harrison         11               N/A           N/A        N/A
       Brentwood Behavioral Health Care    Rankin           59              23,048       107.03      14.82
       Diamond Grove Center                Winston          20     20a      7,288         99.84      21.62
       Forrest General Hospital            Forrest          16       0      6,757        115.70       8.31
       Memorial Hospital at Gulfport       Harrison         30       0      5,894         53.83      10.07
       Parkwood Behavioral Health System   DeSoto           52       0      17,827        93.93      11.24
       University Hospital & Clinics       Hinds            12       0      1,796         41.00       8.24


       Total Adolescent Psychiatric Beds                    222    20a     76,776         94.75      13.59

   a
    CON approved
   b
    Beds held in abeyance by the MSDH
   * Biloxi Regional Medical Center has 11 licensed adolescent psychiatric beds; however, data was not
   available for the unit.

   Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
   Hospital Report; and Division of Health Planning and Resource Development Computations



   .




Chapter 3– Mental Health                                6                             2011 State Health Plan
                                             Map 3-2
                          Operational and Proposed Inpatient Facilities
                         Serving Adolescent Acute Psychiatric Patients*




2011 State Health Plan                         7                      Chapter 3 – Mental Health
104 Psychiatric Residential Treatment Facilities

   Psychiatric Residential Treatment Facilities (PRTF) serve emotionally disturbed children and
   adolescents who are not in an acute phase of illness that requires the services of a psychiatric
   hospital, but who need restorative residential treatment services. "Emotionally disturbed" in this
   context means a condition exhibiting certain characteristics over a long period of time and to a
   marked degree. The criteria and standards section of this chapter describes these facilities more
   fully. Table 3-3 shows six facilities are in operation with a total of 298 PRTF beds. Map 3-3
   presents the location of the private psychiatric residential treatment facilities throughout the state.
   Children and adolescents who need psychiatric residential treatment beyond the scope of these
   residential treatment centers are served in acute psychiatric facilities or sent out of the state to
   other residential treatment facilities.

                                              Table 3-3
                      Private Psychiatric Residential Treatment Facility (PRTF)
                                              Utilization
                                               FY 2008

                                                                   a
                                                   Licensed/CON         Inpatient Occupancy Average Daily
   Facility                            County      Approved Beds          Days     Rate(%)     Census
   Parkwood BHS                      DeSoto                40             13,860       94.93          37.97
   Cares Center                      Hinds                 60             16,060       73.33          44.00
   The Crossing                      Lauderdale            60             21,901      100.00          60.00
   Millcreek of Pontotoc             Pontotoc              51       0     18,067       97.06          49.50
   Millcreek PRTF                    Simpson               57             20,606       99.04          56.45
   Diamond Grove Center              Winston               30             10,284       93.92          28.18
                                                                                                      0.00
   Total PRTF Beds                                     298               100,778      92.65          276.10
   a
    CON approved
   Source: Mississippi State Department of Health, 2008 Report on Institutions for the Aged or Infirm, and
   Division of Health Planning and Resource Development

   The DMH operates a specialized 48-bed treatment facility in Brookhaven for youth with an
   intellectual and/or developmental disability who are 13 years, but less than 21 years of age. A
   similar facility, licensed as a psychiatric residential treatment facility, is located in Harrison
   County for youth who have come before Youth Court and have also been diagnosed with a mental
   disorder. Adolescents appropriate for admission are 13 years, but less than 21 years of age, who
   present with an Axis I diagnosis of a severe emotional disturbance and need psychiatric residential
   care.




Chapter 3 – Mental Health                              8                              2011 State Health Plan
                                              Map 3-3
                         Private Psychiatric Residential Treatment Facilities




2011 State Health Plan                         9                       Chapter 3 – Mental Health
105 Alcohol and Drug Abuse Services


   105.01      Alcohol and Drug Abuse

       Alcohol and other drug problems cause pervasive effects: biological, psychological, and social
       consequences for the abuser; psychological and social effects on family members and others;
       increased risk of injury and death to self, family members, and others (especially by accidents,
       fires, or violence); and derivative social and economic consequences for society at large.

      The location of facilities with alcohol and drug abuse programs is shown on Maps 3-4 and 3-5.
      Ten general hospitals and two freestanding facilities in Mississippi offer private alcohol and
      drug abuse treatment programs. Tables 3-4 and 3-5 show the utilization of these facilities for
      adult and adolescent chemical dependency services, respectively. The state hospitals at
      Whitfield and Meridian and the Veterans Administration Hospitals in Jackson and Gulfport
      provide inpatient alcohol and drug abuse services. Also, there are four facilities with programs
      designed for targeted populations: 1) the State Penitentiary at Parchman; 2) the Center for
      Independent Learning in Jackson; 3) the Mississippi Band of Choctaw Indians reservation
      treatment program; and 4) the Alcohol Services Center in Jackson. Additionally, each of the 15
      regional community mental health centers provide a variety of alcohol and drug services,
      including residential and transitional treatment programs. A total of 38 such residential
      programs for adults and adolescents are scattered throughout the state. The Mississippi State
      Legislature has placed a moratorium on the approval of new Medicaid-certified
      child/adolescent chemical dependency beds within the state.

                                                      Table 3-4
                                            Adult Chemical Dependency Unit
                                                    Bed Utilization
                                                       FY 2009

                                                                                       a
                                                                      Licensed/CON         Average Daily    Occupancy
     Facility                                            County       Approved Beds           Census         Rate (%)        ALOS
     Alliance Health Center                            Lauderdale       8                      5.76           69.55           5.78
     Baptist Memorial Hospital - Golden Triangle       Lowndes          21                     1.74            8.30           3.92
     Brentwood Behavorial Healthcare *                 Rankin                   4a
     Delta Regional Medical Center                     Washington       7                       3.50           50.06          4.80
     Forrest General Hospital **                       Forrest          32                     10.93           34.16          4.45
     Miss Baptist Medical Center *                     Hinds            77                      1.64           2.13           4.39
     North Miss Medical Center                         Lee              33                      4.24           12.84          3.43
     Parkwood Behavioral Health System                 DeSoto           14                      8.00           57.16          6.85
     River Region Health System                        Warren           28                     14.38           51.35          9.53
     South Central Regional Medical Center             Jones            10                      5.30           53.01          4.93
     St. Dominic Hospital                              Hinds            35                      5.27           15.06          3.76
     Tri-Lakes Medical Center *                        Panola           23                     10.62           46.19          6.93

     Total Adult CDU Beds                                              288        4a           71.20           24.72          5.45
   Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual Hospital Report; Division of
    Health Planning and Resource Development.

   *Brentwood Behavioral Healthcare of Rankin County will lease four beds from Mississippi Baptist Medical Center. Miss
    Baptist Medical Center’s licensed bed count will decrease from 77 to 73. Tri-Lakes Medical Center leases 23 beds from
    Mississippi Baptist Medical Center.
   ** Forrest General Hospital received a CON to convert 24 adult CDU beds to adult psychiatric beds April 2010.



Chapter 3 – Mental Health                                        10                                    2011 State Health Plan
                                                  Table 3-5
                                     Adolescent Chemical Dependency Unit
                                                Bed Utilization
                                                   FY 2009
                                                                                    Average
                                                                 Licensed/CON        Daily       Occupancy
     Facilities                                   County         Approved Beds      Census       Rate (%) *      ALOS
     Memorial Hospital at Gulfport             Harrison                20             5.15         25.77         11.29
     Mississippi Baptist Medical Center *      Hinds                   20             N/A           N/A           N/A
     River Region Health System                Warren                  12             7.81         65.11         13.27
     Total Adolescent CDU Beds *                                       52             12.97         40.52        12.36
   * Mississippi Baptist Medical Center has 20 licensed adolescent CDU beds; however, data was not available for the unit.
   Occupancy rate is based on 32 beds instead of 52 beds.

   Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual Hospital Report;
   Division of Health Planning and Resource Development.




2011 State Health Plan                                      11                               Chapter 3 – Mental Health
                                            Map 3-4
                      Operational and Proposed Adult Chemical Dependency
                                     Programs and Facilities




Chapter 3 – Mental Health                      12                      2011 State Health Plan
                                           Map 3-5
                   Operational and Proposed Adolescent Chemical Dependency
                                    Programs and Facilities




2011 State Health Plan                        13                    Chapter 3 – Mental Health
     CERTIFICATE OF NEED
    CRITERIA AND STANDARDS
             FOR
      ACUTE PSYCHIATRIC,
     CHEMICAL DEPENDENCY,
             AND
    PSYCHIATRIC RESIDENTIAL
TREATMENT FACILITY BEDS/SERVICES
106 Certificate of Need Criteria and Standards for Acute Psychiatric, Chemical
    Dependency, and Psychiatric Residential Treatment Facility Beds/Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


   106.01      Policy Statement Regarding Certificate of Need Applications for Acute Psychiatric,
               Chemical Dependency, and Psychiatric Residential Treatment Facility
               Beds/Services

          1.    An applicant must provide a "reasonable amount" of indigent/charity care as described
                in Chapter I of this Plan.

          2.    Mental Health Planning Areas: The Department of Health shall use the state as a
                whole to determine the need for acute psychiatric beds/services, chemical dependency
                beds/ services, and psychiatric residential treatment beds/services. Tables 3-6, 3-7, and
                3-8 give the statistical need for each category of beds.

          3.    Public Sector Beds: Due to the public sector status of the acute psychiatric, chemical
                dependency, and psychiatric residential treatment facility beds operated directly by the
                Mississippi Department of Mental Health (MDMH), the number of licensed beds
                operated by the MDMH shall not be counted in the bed inventory used to determine
                statistical need for additional acute psychiatric, chemical dependency, and psychiatric
                residential treatment facility beds.

          4.    Comments from Department of Mental Health: The Mississippi State Department of
                Health shall solicit and take into consideration comments received from the
                Mississippi Department of Mental Health regarding any CON application for the
                establishment or expansion of inpatient acute psychiatric, chemical dependency, and/or
                psychiatric residential treatment facility beds.

          5.    Separation of Adults and Children/Adolescents: Child and adolescent patients under
                18 years of age must receive treatment in units which are programmatically and
                physically distinct from adult (18+ years of age) patient units. A single facility may
                house adults as well as adolescents and children if both physical design and staffing
                ratios provide for separation.

          6.    Separation of Males and Females: Facilities must separate males and females age 13
                and over for living purposes (e.g., separate rooms and rooms located at separate ends
                of the halls, etc.).

          7.    Patients with Co-Occurring Disorders: It is frequently impossible for a provider to
                totally predict or control short-term deviation in the number of patients with mixed



2011 State Health Plan                               17                         Chapter 3 – Mental Health
               psychiatric/ addictive etiology to their illnesses. Therefore, the Department will allow
               deviations of up to 25 percent of the total licensed beds as "swing-beds" to
               accommodate patients having diagnoses of both psychiatric and substance abuse
               disorders. However, the provider must demonstrate to the Division of Licensure and
               Certification that the "swing-bed" program meets all applicable licensure and
               certification regulations for each service offered, i.e., acute psychiatric, chemical
               dependency, and psychiatric residential treatment facility services, before providing
               such "swing-bed" services.

         8.    Comprehensive Program of Treatment: Any new mental health beds approved must
               provide a comprehensive program of treatment that includes, but is not limited to,
               inpatient, outpatient, and follow-up services, and in the case of children and
               adolescents, includes an educational component. The facility may provide outpatient
               and appropriate follow-up services directly or through contractual arrangements with
               existing providers of these services.

         9.    Medicaid Participation: An applicant proposing to offer acute psychiatric, chemical
               dependency, and/or psychiatric residential treatment facility services or to establish,
               expand, and/or convert beds under any of the provisions set forth in this section or in
               the service specific criteria and standards shall affirm in the application that:

                a. the applicant shall seek Medicaid certification for the facility/program at such time
                   as the facility/program becomes eligible for such certification; and

                b. the applicant shall serve a reasonable number of Medicaid patients when the
                   facility/program becomes eligible for reimbursement under the Medicaid Program.
                   The application shall affirm that the facility will provide the MSDH with
                   information regarding services to Medicaid patients.

        10.    Licensing and Certification: All acute psychiatric, chemical dependency treatment, co-
               occurring disorders beds /services, and psychiatric residential treatment facility
               beds/services must meet all applicable licensing and certification regulations of the
               Division of Health Facilities Licensure and Certification. If licensure and certification
               regulations do not exist at the time the application is approved, the program shall
               comply with such regulations following their effective date.

        11.    Psychiatric Residential Treatment Facility: A psychiatric residential treatment facility
               (PRTF) is a non-hospital establishment with permanent licensed facilities that provides
               a twenty-four (24) hour program of care by qualified therapists including, but not
               limited to, duly licensed mental health professionals, psychiatrists, psychologists,
               psychotherapists, and licensed certified social workers, for emotionally disturbed
               children and adolescents referred to such facility by a court, local school district, or the
               Department of Human Services, who are not in an acute phase of illness requiring the
               services of a psychiatric hospital and who are in need of such restorative treatment
               services. For purposes of this paragraph, the term "emotionally disturbed" means a
               condition exhibiting one or more of the following characteristics over a long period of
               time and to a marked degree, which adversely affects educational performance:

                a. an inability to learn which cannot be explained by intellectual, sensory, or health
                   factors;




Chapter 3 – Mental Health                            18                             2011 State Health Plan
                b. an inability to build or maintain satisfactory relationships with peers and teachers;

                c. inappropriate types of behavior or feelings under normal circumstances;

                d. a general pervasive mood of unhappiness or depression; or

                e. a tendency to develop physical symptoms or fears associated with personal or
                   school problems.

      An establishment furnishing primarily domiciliary care is not within this definition.

        12.    Certified Educational Programs: Educational programs certified by the Department of
               Education shall be available for all school age patients. Also, sufficient areas suitable
               to meet the recreational needs of the patients are required.

        13.    Preference in CON Decisions: Applications proposing the conversion of existing acute
               care hospital beds to acute psychiatric and chemical dependency beds shall receive
               preference in CON decisions provided the application meets all other criteria and
               standards under which it is reviewed.

        14.    Dedicated Beds for Children's Services: It has been determined that there is a need for
               specialized beds dedicated for the treatment of children less than 14 years of age.
               Therefore, of the beds determined to be needed for child/adolescent acute psychiatric
               services and psychiatric residential treatment facility services, 25 beds under each
               category, for a total of 50 beds statewide, shall be reserved exclusively for programs
               dedicated to children under the age of 14.

        15.    Effective April 12, 2002, no health care facility shall be authorized to add any beds or
               convert any beds to another category of beds without a Certificate of Need under the
               authority of Section 41-7-191(1)(c).

        16.    Effective March 4, 2003, if a health care facility has voluntarily delicensed some of its
               existing bed complement, it may later relicense some or all of its delicensed beds
               without the necessity of having to acquire a Certificate of Need. The Department of
               Health shall maintain a record of the delicensing health care facility and its voluntarily
               delicensed beds and continue counting those beds as part of the state’s total bed count
               for health care planning purposes.

        17.    A health care facility has ceased to operate for a period of 60 months or more shall
               require a Certificate of Need prior to reopening.


   106.02     General Certificate of Need Criteria and Standards for Acute Psychiatric,
              Chemical Dependency, and/or Psychiatric Residential Treatment Facility
              Beds/Services

      The Mississippi State Department of Health will review applications for a Certificate of Need
      for the establishment, offering, or expansion of acute psychiatric, chemical dependency
      treatment, and/or psychiatric residential treatment beds/services under the applicable statutory
      requirements of Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as
      amended. The MSDH will also review applications for Certificate of Need according to the



2011 State Health Plan                              19                         Chapter 3 – Mental Health
      policies in this Plan; the general criteria listed in the Mississippi Certificate of Need Review
      Manual; all adopted rules, procedures, and plans of the Mississippi State Department of
      Health; and the general and service specific criteria and standards listed below.

      The offering of acute psychiatric, chemical dependency treatment, and/or psychiatric
      residential treatment facility services is reviewable if the proposed provider has not offered
      those services on a regular basis within the period of twelve (12) months prior to the time such
      services would be offered. The construction, development, or other establishment of a new
      health care facility to provide acute psychiatric, chemical dependency treatment, and/or
      psychiatric residential treatment services requires CON review regardless of capital
      expenditure.

         1.    Need Criterion:

                a. New/Existing Acute Psychiatric, Chemical Dependency, and/or Psychiatric
                   Residential Treatment Facility Beds/Services: The applicant shall document a
                   need for acute psychiatric, chemical dependency, and/or psychiatric residential
                   treatment facility beds using the appropriate bed need methodology as presented in
                   this section under the service specific criteria and standards.

                b. Projects which do not involve the addition of acute psychiatric, chemical
                   dependency, and/or psychiatric residential treatment facility beds: The applicant
                   shall document the need for the proposed project. Documentation may consist of,
                   but is not limited to, citing of licensure or regulatory code deficiencies,
                   institutional long-term plans duly adopted by the governing board,
                   recommendations made by consultant firms, and deficiencies cited by accreditation
                   agencies (JCAHO, CAP, etc.).

                c. Projects which involve the addition of beds: The applicant shall document the
                   need for the proposed project. Exception: Notwithstanding the service specific
                   statistical bed need requirements as stated in "a" above, the Department may
                   approve additional beds for facilities which have maintained an occupancy rate of
                   at least 80 percent for the most recent 12-month licensure reporting period or at
                   least 70 percent for the most recent two (2) years.

                d. Child Psychiatry Fellowship Program: Notwithstanding the service specific
                   statistical bed need requirements as stated in "a" above, the Department may
                   approve a 15-bed acute child psychiatric unit at the University of Mississippi
                   Medical Center for children aged 4-12 to provide a training site for psychiatric
                   residents.

         2.    The application shall affirm that the applicant will record and maintain, at a minimum,
               the following information regarding charity care and care to the medically indigent and
               make such information available to the Mississippi State Department of Health within
               15 business days of request:

                a. source of patient referral;

                b. utilization data, e.g., number of indigent admissions, number of charity
                   admissions, and inpatient days of care;




Chapter 3 – Mental Health                           20                             2011 State Health Plan
                 c. demographic/patient origin data;

                 d. cost/charges data; and

                 e. any other data pertaining directly or indirectly to the utilization of services by
                    medically indigent or charity patients which the Department may request.

          3.    A CON applicant desiring to provide or to expand chemical dependency, psychiatric,
                and/or psychiatric residential treatment facility services shall provide copies of signed
                memoranda of understanding with Community Mental Health Centers and other
                appropriate facilities within their patient service area regarding the referral and
                admission of charity and medically indigent patients.

          4.    Applicants should also provide letters of comment from the Community Mental Health
                Centers, appropriate physicians, community and political leaders, and other interested
                groups that may be affected by the provision of such care.

          5.    The application shall document that within the scope of its available services, neither
                the facility nor its participating staff shall have policies or procedures which would
                exclude patients because of race, color, age, sex, ethnicity, or ability to pay.

      The application shall document that the applicant will provide a reasonable amount of
      charity/indigent care as provided for in Chapter I of this Plan.


   106.03      Service Specific Certificate of Need Criteria and Standards for Acute Psychiatric,
               Chemical Dependency, and/or Psychiatric Residential Treatment Facility
               Beds/Services


      106.03.01 Acute Psychiatric Beds for Adults

               1. The Mississippi State Department of Health shall base statistical need for adult acute
                  psychiatric beds on a ratio of 0.21 beds per 1,000 population aged 18 and older for
                  2010 in the state as a whole as projected by the Division of Health Planning and
                  Resource Development. Table 3-6 presents the statistical need for adult psychiatric
                  beds.

               2. The applicant shall provide information regarding the proposed size of the
                  facility/unit. Acute psychiatric beds for adults may be located in either freestanding
                  or hospital-based facilities. Freestanding facilities should not be larger than 60 beds.
                  Hospital units should not be larger than 30 beds. Patients treated in adult facilities
                  and units should be 18 years of age or older.

               3. The applicant shall provide documentation regarding the staffing of the facility. Staff
                  providing treatment should be specially trained for the provision of psychiatric and
                  psychological services. The staff should include both psychiatrists and psychologists
                  and should provide a multi-discipline psychosocial medical approach to treatment.




2011 State Health Plan                                21                         Chapter 3 – Mental Health
      106.03.02 Acute Psychiatric Beds for Children and Adolescents

             1. The Mississippi State Department of Health shall base statistical need for
                child/adolescent acute psychiatric beds on a ratio of 0.55 beds per 1,000 population
                aged 7 to 17 for 2010 in the state as a whole as projected by the Division of Health
                Planning and Resource Development. Table 3-6 presents the statistical need for
                child/adolescent psychiatric beds. Of the specified beds needed, 25 beds are hereby
                set aside exclusively for the treatment of children less than 14 years of age.

             2. The applicant shall provide information regarding the proposed size of the
                facility/unit. Acute psychiatric beds for children and adolescents may be located in
                freestanding or hospital-based units and facilities. A facility should not be larger than
                60 beds. All units, whether hospital-based or freestanding, should provide a homelike
                environment. Ideally, a facility should provide cottage-style living units housing
                eight to ten patients. Because of the special needs of children and adolescents,
                facilities or units which are not physically attached to a general hospital are preferred.
                For the purposes of this Plan, an adolescent is defined as a minor who is at least 14
                years old but less than 18 years old, and a child is defined as a minor who is at least 7
                years old but less than 14 years old.

             3. The applicant shall provide documentation regarding the staffing of the facility. Staff
                should be specially trained to meet the needs of adolescents and children. Staff
                should include both psychiatrists and psychologists and should provide a
                multi-discipline psychosocial medical approach to treatment. The treatment program
                must involve parents and/or significant others. Aftercare services must also be
                provided.

             4. The applicant shall describe the structural design of the facility in providing for the
                separation of children and adolescents. In facilities where both children and
                adolescents are housed, the facility should attempt to provide separate areas for each
                age grouping.


      106.03.03 Chemical Dependency Beds for Adults

             1. The Mississippi State Department of Health shall base statistical need for adult
                chemical dependency beds on a ratio of 0.14 beds per 1,000 population aged 18
                and older for 2010 in the state as a whole as projected by the Division of Health
                Planning and Resource Development. Table 3-7 presents the statistical need for adult
                chemical dependency beds.

             2. The applicant shall provide information regarding the proposed size of the
                facility/unit. Chemical dependency treatment programs may be located in either
                freestanding or hospital-based facilities. Facilities should not be larger than 75 beds,
                and individual units should not be larger than 30 beds. The bed count also includes
                detoxification beds. Staff should have specialized training in the area of alcohol and
                substance abuse treatment, and a multi-discipline psychosocial medical treatment
                approach which involves the family and significant others should be employed.




Chapter 3 – Mental Health                           22                             2011 State Health Plan
             3. The applicant shall describe the aftercare or follow-up services proposed for
                individuals leaving the chemical dependency program. Chemical dependency
                treatment programs should include extensive aftercare and follow-up services.

             4. The applicant shall specify the type of clients to be treated at the proposed facility.
                Freestanding chemical dependency facilities and hospital-based units should provide
                services to substance abusers as well as alcohol abusers.


      106.03.04 Chemical Dependency Beds for Children and Adolescents

             1. The Mississippi State Department of Health shall base statistical need for
                child/adolescent chemical dependency beds on a ratio of 0.44 beds per 1,000
                population aged 12 to 17 for 2010 in the state as a whole as projected by the
                Division of Health Planning and Resource Development. Table 3-7 presents the
                statistical need for child/adolescent chemical dependency beds.

             2. The applicant shall provide information regarding the proposed size of the
                facility/unit. Chemical dependency beds may be located in either freestanding or
                hospital-based facilities. Because of the unique needs of the child and adolescent
                population, facilities shall not be larger than 60 beds. Units shall not be larger than 20
                beds. The bed count of a facility or unit will include detoxification beds.

                 Facilities or units, whether hospital-based or freestanding, should provide a
                 home-like environment. Ideally, facilities should provide cottage-style living units
                 housing eight to ten patients. Because of the special needs of children and
                 adolescents, facilities or units which are not physically attached to a general hospital
                 are preferred.

             3. The applicant shall provide documentation regarding the staffing of the facility. Staff
                should be specially trained to meet the needs of adolescents and children. Staff
                should include both psychiatrists and psychologists and should provide a
                multi-discipline psychosocial medical approach to treatment. The treatment program
                must involve parents and significant others. Aftercare services must also be provided.

             4. The applicant shall describe the structural design of the facility in providing for the
                separation of the children and adolescents. Child and adolescent patients shall be
                separated from adult patients for treatment and living purposes.

             5. The applicant shall describe the aftercare or follow-up services proposed for
                individuals leaving the chemical dependency program. Extensive aftercare and
                follow-up services involving the family and significant others should be provided to
                clients after discharge from the inpatient program. Chemical dependency facilities
                and units should provide services to substance abusers as well as alcohol abusers.


      106.03.05 Psychiatric Residential Treatment Facility Beds/Services

             1. The Mississippi State Department of Health shall base statistical need for psychiatric
                residential treatment beds on a ratio of 0.4 beds per 1,000 population aged 5 to 21
                for 2010 in the state as a whole as projected by the Division of Health Planning and



2011 State Health Plan                               23                         Chapter 3 – Mental Health
                Resource Development. Table 3-8 presents the statistical need for psychiatric
                residential treatment facility beds.

             2. The application shall state the age group that the applicant will serve in the
                psychiatric residential treatment facility and the number of beds dedicated to each
                age group (5 to 13, 14 to 17, and 18 to 21).

             3. The applicant shall describe the structural design of the facility for the provision of
                services to children less than 14 years of age. Of the beds needed for psychiatric
                residential treatment facility services, 25 beds are hereby set aside exclusively for the
                treatment of children less than 14 years of age. An applicant proposing to provide
                psychiatric residential treatment facility services to children less than 14 years of age
                shall make provision for the treatment of these patients in units which are
                programmatically and physically distinct from the units occupied by patients older
                than 13 years of age. A facility may house both categories of patients if both the
                physical design and staffing ratios provide for separation.

             4. This criterion does not preclude more than 25 psychiatric residential treatment
                facility beds being authorized for the treatment of patients less than 14 years of age.
                However, the Department shall not approve more psychiatric residential treatment
                facility beds statewide than specifically authorized by legislation (Miss. Code Ann. §
                41-7-191 et. seq). This authorization is limited to 334 beds for the entire state.
                (Note: the 298 licensed and CON approved beds indicated in Table 3-8 were the
                result of both CON approval and legislative actions).

             5. The applicant shall provide information regarding the proposed size of the
                facility/unit. A psychiatric residential treatment facility should provide services in a
                homelike environment. Ideally, a facility should provide cottage-style living units not
                exceeding 15 beds. A psychiatric residential treatment facility should not be larger
                than 60 beds.

             6. The applicant shall provide documentation regarding the staffing of the facility. Staff
                should be specially trained to meet the treatment needs of the age category of patients
                being served. Staff should include both psychiatrists and psychologists and should
                provide a multi-discipline psychosocial medical approach to treatment. The treatment
                program must involve parents and/or significant others. Aftercare/follow-up services
                must also be provided.




Chapter 3 – Mental Health                           24                             2011 State Health Plan
                                            Table 3-6
                               Statewide Acute Psychiatric Bed Need
                                               2010
                                                                    Licensed/CON
                                         2010 Projected Projected Approved/Abeyance
        Bed Category and Ratio             Population   Bed Need        Beds        Difference
      Adult Psychiatric:
      0.21 beds per 1,000 population
      aged 18+                             2,238,274           470                576              -106
      Child/Adolescent Psychiatric:
      0.55 beds per 1,000 population
      aged 7 to 17                           452,740           249                242                     7

   Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
   Hospital Report; and Division of Health Planning and Resource Development calculations

                                            Table 3-7
                             Statewide Chemical Dependency Bed Need
                                              2010

                                           2010 Projected     Projected    Licensed/CON
          Bed Category and Ratio             Population       Bed Need     Approved Beds Difference
        Adult Chemical Dependency:
        0.14 beds per 1,000 population
        aged 18+                             2,238,274            313            292                 21
        Child/Adolescent Chemical
        Dependency: 0.44 beds per 1,000
        population aged 12 to 17               251,695            111             52                 59

    Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
    Hospital Report; Division of Health Planning and Resource Development calculations, June 2010



                                               Table 3-8
                                    Statewide Psychiatric Residential
                                      Treatment Facility Bed Need
                                                 2010


                      Bed Ratio per 2010 Projected Projected Licensed/CON
    Age Cohort       1,000 Population Population   Bed Need Approved Beds Difference
       5 to 21             0.40        704,365       282          298         -16
    Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
    Hospital Report; and Division of Health Planning and Resource Development calculations, June 2010




2011 State Health Plan                                 25                       Chapter 3 – Mental Health
107    Private Distinct-Part Geriatric Psychiatric Services

   During 2009, 40 Mississippi hospitals operated certified distinct-part geriatric psychiatric units
   (Geropsych DPU) with a total of 518 beds. Geropsych units receive Medicare certification as a
   distinct-part psychiatric unit but are licensed as short-term acute hospital beds. These Geropsych
   units served a total of 95,047 inpatient days of psychiatric services to 7,754 patients aged 55 and
   older.

   The industry standard formula for determining Geropsych DPU beds need is 0.5 beds need per
   1,000 population aged 55 and over. The Office of Policy Research and Planning, Mississippi
   Institute of Higher Learning, projects that Mississippi will have 781,088 persons aged 55 and
   older by 2010. This population will need a total of 391 Geropsych DPU beds. The optimum unit
   size of a Geropsych unit is 12 to 24 beds. Table 3-9 shows the state’s 37 distinct-part geriatric
   psychiatric units. County population projections can be found in Chapter 1 of this Plan.




Chapter 3 – Mental Health                           26                            2011 State Health Plan
                                                     Table 3-9
                                        Geriatric Psychiatric Bed Utilization
                                                      FY 2009


                                                     Certified Inpatient Occupancy                          Discharge
                 Facility                 County       Beds      Days     Rate (%)    Discharges   ALOS        Days
               State Total                             518        95,047      50.27      7,754      12.25       94,963
Alliance Health Center                  Lauderdale      12        3,073       70.16      218        13.35         2,911
Alliance Healthcare System              Marshall        20        1,787       24.48      202         8.95        1,808
Baptist Memorial Hospital-Booneville    Prentiss        15        3,247       59.31      256        12.57        3,217
Biloxi Regional Medical Center          Harrison        12        2,823       64.45      245        11.61        2,844
Calhoun Health Services                 Calhoun         9         1,465       44.60      126        11.69        1,473
Central Mississippi Medical Center      Hinds           18        1,849       28.14      216         8.38        1,810
Choctaw County Medical Center           Choctaw         8         1,855       63.53      143        13.03        1,863
Claiborne County Hospital               Claiborne       10        2,522       69.10      186        13.39        2,491
Covington County Hospital               Covington       10        2,218       60.77      159        14.19        2,256
Delta Regional MC-West Campus           Washington      14        2,566       50.22      246        10.41        2,560
Franklin County Memorial Hospital       Franklin        12        2,474       56.48      168        13.64        2,292
Garden Park Medical Center              Harrison        12        2,624       59.91      225        11.70        2,632
George County Hospital                  George          10        1,797       49.23      164        10.95        1,796
Greenwood Leflore Hospital              Leflore         15        3,306       60.38      276        12.13        3,347
Grenada Lake Medical Center             Grenada         14           62        1.21       3         10.33           31
Hardy Wilson Memorial Hospital          Copiah          10          897       24.58      73         11.82          863
Jefferson County Hospital               Jefferson       18        5,899       89.79      363        15.76        5,721
Jefferson Davis Community Hospital      Jeff Davis      10        2,301       63.04      169        13.30        2,247
Kings Daughters Hospital                Yazoo           10        2,360       64.66      196        12.09        2,369
Mississippi Baptist Medical Center      Hinds           24        4,232       48.31      318        13.66        4,343
Montfort Jones Memorial Hospital        Attala          11        1,686       41.99      135        12.41        1,675
Natchez Regional Medical Center         Adams           12        2,325       53.08      236        10.89        2,569
Neshoba County General Hospital         Neshoba         10        1,521       41.67      154        10.01        1,542
Newton Regional Hospital                Newton          9         2,155       65.60      159        13.60        2,162
North Oak Regional Medical Center       Tate            12        2,114       48.26      159        13.14        2,089
North Sunflower County Hospital         Sunflower       10        2,912       79.78      234        12.81        2,997
Patient's Choice-Humphreys County       Humphreys       9         3,075       93.61      232        14.37        3,334
Patient's Choice Medical Center         Smith           10          147        4.03      19         12.25          147
Pioneer Community Hospital-Aberdeen     Monroe          10        1,950       53.42      159        12.03        1,913
Quitman County Hospital                 Quitman         8         1,617       55.38      109        15.28        1,665
Rankin Medical Center                   Rankin          15        4,345       79.36      309        14.06        4,345
River Region Health System              Warren          27        4,063       41.23      400        10.20        4,080
S. E. Lackey Critical Access Hospital   Scott           10        2,492       68.27      194        11.98        2,325
Sharkey-Issaquena Com. Hospital         Sharkey         10        1,660       45.48      146        11.30        1,650
Simpson General Hospital                Simpson         10        2,119       57.90      158        14.48        2,288
South Cent. Regional Medical Center     Jones           18        2,695       41.02      231        11.19        2,584
Tippah County Hospital                  Tippah          10        2,198       60.22      180        11.19        2,014
Trace Regional Hospital                 Chickasaw       18        1,971       30.00      160        12.39        1,983
Tri-Lakes Medical Center                Panola          22        2,554       31.81      262         9.99        2,618
Winston Medical Center                  Winston         14        2,091       40.92      166        12.70        2,109

Sources: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual Hospital
Report; and Division of Health Planning and Resource Development calculations, June 2010.




2011 State Health Plan                                       27                          Chapter 3 – Mental Health
  CHAPTER 4
PERINATAL CARE
Chapter 4 Perinatal Care

100 Natality Statistics

      Mississippi experienced 44,904 live births in 2008; 54.0 percent of these (24,229) were white
      and 46.0 percent (20,674) were nonwhite. A physician attended 97.9 percent of all in-hospital
      live births delivered in 2008 (43,852). Nurse midwife deliveries accounted for 850 live births.

      More than 99 percent of the live births occurred to women 15 to 44 years age. Births to
      unmarried women made up 45.4 percent (24,436) of all live births in 2008; of these, 66.7
      percent (16309) were nonwhite. Mothers under the age of 15 gave birth to 130 children; 76.9
      percent (130) were nonwhite.

      The birth rate in 2008 was 15.3 live births per 1,000 population; the fertility rate was 74.3 live
      births per 1,000 women aged 15-44 years.

      Mississippi reported 470 fetal deaths in 2008. The fetal death rate for non-whites was almost
      2.5 times that of whites, with a rate of 15.4 for non-whites compared to 6.2 for whites. Mothers
      aged 40-44 had the highest fetal death rate at 20.0 per 1,000 live births, followed by mothers
      under the age of 15 with a rate of 15.4. Next were mothers aged 15-19, having a rate of 12.4.
      The MSDH requires the reporting of fetal deaths with gestation of 20 or more weeks or fetal
      weight of 350 grams or more.

      There were 14 maternal deaths were reported during 2008. Maternal mortality refers to deaths
      resulting from complications of pregnancies, childbirth, or the puerperium within 42 days of
      delivery.


101       Infant Mortality

      Infant mortality remains a critical concern in Mississippi, with the rate increasing to 10.3
      deaths per 1,000 live births in 2008 from 10.1 in 2007, which was the highest in several years.
      Table 4-1 shows the 2008 infant mortality rate, neonatal, and post-neonatal mortality for non-
      whites all substantially above the rates for whites. (Note: 2008 vital statistics data is the most
      recent currently available.)

                                               Table 4-1
                            2008 Mortality Rates (deaths per 1,000 live births)

                              Category                          Overall         White       Non-White
                                                               State Rate       Rate          Rate

             Total Infant Mortality (age under one year)
                                                                   10.3           6.8           14.5

               Neonatal Mortality (age under 28 days)
                                                                   6.1            3.7            9.0

          Postneonatal Mortality (age 28 days to one year)
                                                                   4.2            3.0            5.5


2011 State Health Plan                              1                           Chapter 4 – Perinatal Care
       Table 4-2 presents Mississippi’s infant mortality rates from 1998 to 2008, along with the rates
       for Region IV and for the United States. Map 4-1 shows the five-year average infant mortality
       rate by county for the period 2004 to 2008.

                                                  Table 4-2
                                           Infant Mortality Rates
                                Mississippi, Region IV and USA – All Races
                                                1998– 2008
              Year               Mississippi                Region IV                    USA
              2008                   9.9                       N/A                       N/A
              2007                  10.0                        8.0                       6.8
              2006                  10.5                        8.1                       6.7
              2005                  11.4                        8.1                       6.9
              2004                   9.7                        8.1                       6.8
              2003                  10.7                        8.2                       6.9
              2002                  10.4                        8.4                       7.0
              2001                  10.4                        8.2                       6.8
              2000                  10.5                        8.3                       6.9
              1999                  10.2                        8.4                       7.1
              1998                  10.2                        8.5                       7.2

      N/A – Not Available
      Source: Office of Health Informatics, Mississippi State Department of Health, 2008
      RNDMU – Region IV Network for Utilization Data Management and Utilization – September 2009

       Many factors contribute to Mississippi's high infant mortality rate: the high incidence of
       teenage pregnancy, low birthweight, low levels of acquired education, low socioeconomic
       status, lack of access for planned delivery services, and lack of adequate perinatal and acute
       medical care.

       More than 98 percent of expectant mothers received some level of prenatal care in 2008. More
       than 81 percent 36,657) began prenatal care in the first trimester; 13.7 percent (6,143) began in
       the second trimester, and 2.3 percent 1,023) during the third trimester. More than one percent
       (615) of expectant mothers received no prenatal care prior to delivery; the month was unknown
       for 292 mothers (0.6 percent); and it was unknown whether 174 mothers (0.4 percent) received
       any prenatal care. White mothers usually receive initial prenatal care much earlier in
       pregnancy than do nonwhites.

       In 2008, 11.8 percent of births were low birthweight (less than 5.5 pounds – 2,500 grams) and
       17.7 percent were premature (gestation age less than 37 weeks). These indicators differ
       markedly by race of the mother: 8.5 percent of white births were low birthweight compared to
       15.8 percent for nonwhites, and 14.5 percent of white births were premature versus 21.5
       percent for nonwhites.

       A total of 7310 Mississippi teenagers gave birth in 2008 —16.3 percent of the state's 44,904
       live births. Until 2008 births to teenagers have increased each year since 2005, and the 2008
       number represents an 8.1 percent decrease from the 7,954 births to teenagers in 2007. Teen
       pregnancy is one of the major reasons for school drop-out. Teenage mothers are (a) more likely



Chapter 4 – Perinatal Care                          2                             2011 State Health Plan
      to be unmarried; (b) less likely to get prenatal care before the second trimester; (c) at higher
      risk of having low birthweight babies; (d) more likely to receive public assistance; (e) at
      greater risk for abuse or neglect; and (f) more likely to have children who will themselves
      become teen parents. In 2008, 13.1 percent of the births to teenagers were low birthweight, and
      19.0 percent were premature.

      Of the 44,904 total births in 2008, 34,410 were associated with "at risk" mothers (76.6
      percent). ―At risk" factors include mothers who are and/or have:

             under 17 years of age or above 35 years of age;

             unmarried;

             completed fewer than eight years of school;

             had fewer than five prenatal visits;

             begun prenatal care in the third trimester;

             had previous terminations of pregnancy; and/or

             a short inter-pregnancy interval (prior delivery within 11 months of conception for the
             current pregnancy).


102     Physical Facilities for Perinatal Care

      The 49 hospitals that experienced live births reported 42,077 deliveries. Four of these hospitals
      reported more than 2,000 obstetrical deliveries each in Fiscal Year 2009, accounting for 10,361
      deliveries or 25 percent of the state's total hospital deliveries: the University Hospital and
      Health Systems, with 3,190 deliveries; Forrest General Hospital, with 2,706; North Mississippi
      Medical Center, with 2,298; and Baptist Memorial Hospital-DeSoto, with 2,167 deliveries.
      These hospitals with a large number of deliveries are strategically located in north, central, and
      south Mississippi. Table 4-3 presents the hospitals in the state reporting deliveries in 2008 and
      2009.




2011 State Health Plan                              3                         Chapter 4 – Perinatal Care
                                               Map 4-1
                             Infant Mortality Rates by County of Residence
                                  2004 to 2008 (Five – Year Average)




Chapter 4 – Perinatal Care                      4                            2011 State Health Plan
                                             Table 4-3
                     Utilization Data for Hospitals with Obstetrical Deliveries
                                       FY 2008 and FY 2009
                                                                      Number of     Number of
                                                                      Deliveries    Deliveries
    Facility                                             County          2008         2009
    University Hospital & Clinics                    Hinds            3,218           3,190
    Forrest General Hospital                         Forrest          2,616           2,706
    North Mississippi Medical Center                 Lee              2,500           2,298
    Baptist Memorial Hospital-DeSoto                 DeSoto           2,142           2,167

    River Oaks Hospital                              Rankin           1,780           1,809
    Wesley Medical Center                            Lamar            1,624           1,688
    Woman's Hospital at River Oaks                   Rankin           1,593           1,634
    St. Dominic-Jackson Memorial Hospital            Hinds            1,544           1,412

    Memorial Hospital at Gulfport                    Harrison         1,422           1,388
    Jeff Anderson Regional Medical Center            Lauderdale       1,413           1,351
    Central Mississippi Medical Center               Hinds            1,282           1,198
    Mississippi Baptist Medical Center               Hinds            1,247           1,104

    Ocean Springs Hospital                           Jackson            955           1,095
    Baptist Memorial Hospital - Union County         Union            1,167           1,092
    Delta Regional Medical Center-Main Campus        Washington         859           1,059
    Southwest Mississippi Regional Medical Center    Pike             1,129           1,032

    Baptist Memorial Hospital-Golden Triangle        Lowndes          1,106           1,006
    Rush Foundation Hospital                         Lauderdale         877             968
    South Central Regional Medical Center            Jones            1,096             964
    Baptist Memorial Hospital - North Miss           Lafayette          994             958

    Northwest Mississippi Regional Medical Center    Coahoma          1,022             954
    Oktibbeha County Hospital                        Oktibbeha        1,069             945
    River Region Health System                       Warren           1,072             870
    Greenwood Leflore Hospital                       Leflore            876             816

    Biloxi Regional Medical Center                   Harrison           848             784
    Singing River Hospital                           Jackson            662             683
    King's Daughters Medical Center-Brookhaven       Lincoln            690             677
    Natchez Community Hospital                       Adams              556             637




2011 State Health Plan                           5                       Chapter 4 – Perinatal Care
                                         Table 4-3 (continued)
                    Utilization Data for Hospitals with Obstetrical Deliveries
                                         FY 2008 and FY 2009
                                                                        Number of                       Number of
                                                                        Deliveries                      Deliveries
       Facility                                            County          2008                           2009
       Garden Park Medical Center                       Harrison           530                            590
       Grenada Lake Medical Center                      Grenada            571                            574
       Magnolia Regional Health Center                  Alcorn             585                            550
       Gilmore Memorial Regional Medical Center         Monroe             540                            507
       Natchez Regional Medical Center                            Adams                   571               504
       North Miss Medical Center-West Point                       Clay                    552               464
       Riley Memorial Hospital                                    Lauderdale              384               355
       South Sunflower County Hospital                            Sunflower               353               334
       Bolivar Medical Center                                     Bolivar                 421               316
       Madison County Medical Center                              Madison                 341               314
       Highland Community Hospital                                Pearl River             404               306
       Hancock Medical Center                                     Hancock                 258               268
       Wayne General Hospital                                     Wayne                   239               232
       Tri-Lakes Medical Center                                   Panola                  140               166
       Magee General Hospital                                     Simpson                 112                95
       George County General Hospital                             George                  211                 8
       Holmes County Hospital and Clinics                         Holmes                     5                2
       Patients Choice Medical Center                             Claiborne                  0                2
       S.E. Lackey Memorial Hospital                              Scott                      3                2
       Scott Regional Hospital                                    Scott                      1                2
       Newton Regional Hospital                                   Newton                     0                1

       Alliance HeaklthCare System                                                          0                 0
       Baptist Memorial Hospital Booneville                       Prentiss                  0                 0
       Covington County Hospital                                  Covington                32                 0
       Gulf Coast Medcial Center                                  Harrison                  0                 0
       Jefferson Davis Community Hospital                         Jeff Davis                0                 0
       King's Daughters-Yazoo City                                Yazoo                    13                 0
       Laird Hospital                                             Newton                    1                 0
       Leake Memorial Hospital                                    Leake                     7                 0
       Marion General Hospital                                    Marion                   2                 0
       Neshoba County General Hospital                            Neshoba                  3                 0
       Stone County Hospital                                      Marion                   1                 0
       Total                                                                            43,639            42,077


      Sources: Applications for Renewal of Hospital License for Calendar Years 2010 and 2009 and Fiscal Years 2009 and
      2008 Annual Hospital Report, Mississippi State Department of Health



Chapter 4 – Perinatal Care                               6                                  2011 State Health Plan
 CERTIFICATE OF NEED
CRITERIA AND STANDARDS
        FOR
OBSTETRICAL SERVICES
103     Certificate of Need Criteria and Standards for Obstetrical Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


  103.01        Policy Statement Regarding Certificate of Need Applications for the Offering of
                Obstetrical Services

           1.     An applicant is required to provide a reasonable amount of indigent/charity care as
                  described in Chapter 1 of this Plan.

           2.     Perinatal Planning Areas (PPA): The MSDH shall determine the need for obstetrical
                  services using the Perinatal Planning Areas as outlined on Map 4-3 at the end of this
                  chapter.

           3.     Travel Time: Obstetrical services should be available within one (1) hour normal
                  travel time of 95 percent of the population in rural areas and within 30 minutes normal
                  travel time in urban areas.

           4.     Preference in CON Decisions: The MSDH shall give preference in CON decisions to
                  applications that propose to improve existing services and to reduce costs through
                  consolidation of two basic obstetrical services into a larger, more efficient service over
                  the addition of new services or the expansion of single service providers.

           5.     Patient Education: Obstetrical service providers shall offer an array of family planning
                  and related maternal and child health education programs that are readily accessible to
                  current and prospective patients.

           6.     Levels of Care:

                  Basic Perinatal Centers provide basic inpatient care for pregnant women and
                  newborns without complications.

                  Specialty Perinatal Centers – provide management for certain high-risk pregnancies,
                  including maternal referrals from basic care centers as well as basic perinatal services.

                  Subspecialty Perinatal Centers – provide inpatient care for maternal and fetal
                  complications as well as basic and specialty care.

           7.     An applicant proposing to offer obstetrical services shall be equipped to provide basic
                  perinatal services in accordance with the guidelines contained in the Minimum
                  Standards of Operation for Mississippi Hospitals § 130, Obstetrics and Newborn
                  Nursery. Hospitals proposing to offer specialty and subspecialty care for high risk

2011 State Health Plan                                  9                         Chapter 4 – Perinatal Care
                  neonates shall conform to the recommendations of the American Academy of
                  Pediatrics, Policy Statement, Levels of Care (PEDIATRICS Vol. 114, No. 5,
                  November, 2004).

           8.     An applicant proposing to offer obstetrical services shall agree to provide an amount of
                  care to Medicaid mothers/babies comparable to the average percentage of Medicaid
                  care offered by other providers of the requested service within the same, or most
                  proximate, geographic area.


  103.02        Certificate of Need Criteria and Standards for Obstetrical Services

       The Mississippi State Department of Health will review applications for a Certificate of Need
       to establish obstetric services under the statutory requirements of Sections 41-7-173, 41-7-191,
       and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review applications
       for Certificate of Need according to the general criteria listed in the Mississippi Certificate of
       Need Review Manual; all adopted rules, procedures, and plans of the Mississippi State
       Department of Health; and the specific criteria and standards listed below.

       The establishment of obstetrical services or the expansion of the existing service shall require
       approval under the Certificate of Need statute if the $2,000,000 capital expenditure threshold is
       crossed.

       Provision for individual units should be consistent with the regionalized perinatal care system
       involved. Those facilities desiring to provide obstetric services shall meet the Basic facility
       minimum standards as listed under Guidelines for the Operation of Perinatal Units found at the
       end of this chapter.

           1.     Need Criterion:

                  The application shall demonstrate how the applicant can reasonably expect to
                  deliver a minimum of 150 babies the first full year of operation and 250 babies by
                  the second full year. In this demonstration, the applicant shall document the
                  number of deliveries performed in the proposed perinatal planning area (as
                  described in Section 103.01, policy statement 2, by hospital.

           2.     The application shall document that the facility will provide one of the three types of
                  perinatal services: Basic, Specialty, or Subspecialty.

           3.     The facility shall provide full-time nursing staff in the labor and delivery area on all
                  shifts. Nursing personnel assigned to nursery areas in Basic Perinatal Centers shall be
                  under the direct supervision of a qualified professional nurse.

           4.     Any facility proposing the offering of obstetrical services shall have written policies
                  delineating responsibility for immediate newborn care, resuscitation, selection and
                  maintenance of necessary equipment, and training of personnel in proper techniques.

           5.     The application shall document that the nurse, anesthesia, neonatal resuscitation, and
                  obstetric personnel required for emergency cesarean delivery shall be in the hospital or
                  readily available at all times.


Chapter 4 – Perinatal Care                             10                            2011 State Health Plan
          6.   The application shall document that the proposed services will be available within one
               (1) hour normal driving time of 95 percent of the population in rural areas and within
               30 minutes normal driving time in urban areas.

          7.   The applicant shall affirm that the hospital will have protocols for the transfer of
               medical care of the neonate in both routine and emergency circumstances.

          8.   The application shall affirm that the applicant will record and maintain, at a minimum,
               the following information regarding charity care and care to the medically indigent and
               make it available to the Mississippi State Department of Health within 15 business
               days of request:

                   a. source of patient referral;

                   b. utilization data, e.g., number of indigent admissions, number of charity
                      admissions, and inpatient days of care;

                   c. demographic/patient origin data;

                   d. cost/charges data; and

                   e. Any other data pertaining directly or indirectly to the utilization of services by
                      medically indigent or charity patients which the Department may request.

          9.   The applicant shall document that within the scope of its available services, neither the
               facility nor its participating staff shall have policies or procedures which would
               exclude patients because of race, age, sex, ethnicity, or ability to pay.




2011 State Health Plan                              11                          Chapter 4 – Perinatal Care
     CERTIFICATE OF NEED
   CRITERIA AND STANDARDS
             FOR
NEONATAL SPECIAL CARE SERVICES
104 Certificate of Need Criteria and Standards for Neonatal Special Care Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


  104.01        Policy Statement Regarding Certificate of Need Applications for the Offering of
                Neonatal Special Care Services

           1.     An applicant is required to provide a reasonable amount of indigent/charity care as
                  described in Chapter 1 of this Plan.

           2.     Perinatal Planning Areas (PPA): The MSDH shall determine the need for neonatal
                  special care services using the Perinatal Planning Areas as outlined on Map 4-3 at the
                  end of this chapter.

           3.     Bed Limit: The total number of neonatal special care beds should not exceed four (4)
                  per 1,000 live births in a specified PPA as defined below:

                      a. one (1) intensive care bed per 1,000 live births; and

                      b. three (3) intermediate care beds per 1,000 live births.

           4.     Size of Facility: A single neonatal special care unit (Specialty or Subspecialty) should
                  contain a minimum of 15 beds.

           5.     Levels of Care:

                  Basic — Units provide uncomplicated care.

                  Specialty — Units provide basic, intermediate, and recovery care as well as specialized
                  services.

                  Subspecialty — Units are staffed and equipped for the most intensive care of newborns
                  as well as intermediate and recovery care.

           6.     An applicant proposing to offer neonatal special care services shall agree to provide an
                  amount of care to Medicaid babies comparable to the average percentage of Medicaid
                  care offered by the other providers of the requested services.


  104.02        Certificate of Need Criteria and Standards for Neonatal Special Care Services

      The Mississippi State Department of Health will review applications for a Certificate of Need
      to establish neonatal special care services under the statutory requirements of Sections 41-7-


2011 State Health Plan                                15                           Chapter 4 – Perinatal Care
       173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also
       review applications for Certificate of Need according to the general criteria listed in the
       Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of the
       Mississippi State Department of Health; and the specific criteria and standards listed below.

       Neonatal special care services are reviewable under Certificate of Need when either the
       establishment or expansion of the services involves a capital expenditure in excess of
       $2,000,000.

      Those facilities desiring to provide neonatal special care services shall meet the capacity and
      levels of neonatal care for the specified facility (Specialty or Subspecialty) as recommended by
      the American Academy of Pediatrics, Policy Statement, Levels of Neonatal Care
      (PEDIATRICS Vol. 114 No. 5 November 2004).

          1.   Need Criterion: The application shall demonstrate that the Perinatal Planning
               Area (PPA) wherein the proposed services are to be offered had a minimum of
               3,600 deliveries for the most recent 12-month reporting period. The MSDH shall
               determine the need for neonatal special care services based upon the following:

                   a. one (1) neonatal intensive (subspecialty) care bed per 1,000 live births in a
                      specified Perinatal Planning Area for the most recent 12-month reporting
                      period; and

                   b. three (3) neonatal intermediate (specialty) care beds per 1,000 live births
                      in a specified Perinatal Planning Area for the most recent 12-month
                      reporting period.

                        Projects for existing providers of neonatal special care services which seek to
                        expand capacity by the addition or conversion of neonatal special care beds:
                        The applicant shall document the need for the proposed project. The applicant
                        shall demonstrate that the facility in question has maintained an occupancy rate
                        for neonatal special care services of at least 70 percent for the most recent two
                        (2) years or 80 percent neonatal special care services occupancy rate for the
                        most recent year, notwithstanding the neonatal special care bed need outlined
                        in Table 4-4 below. The applicant may be approved for such additional or
                        conversion of neonatal special care beds to meet projected demand balanced
                        with optimum utilization rate for the Perinatal Planning Area.

          2.   A single neonatal special care unit (Specialty or Subspecialty) should contain a
               minimum of 15 beds (neonatal intensive care and/or neonatal intermediate care). An
               adjustment downward may be considered for a specialty unit when travel time to an
               alternate unit is a serious hardship due to geographic remoteness.

          3.   The application shall document that the proposed services will be available within one
               (1) hour normal driving time of 95 percent of the population in rural areas and within
               30 minutes normal driving time in urban areas.

          4.   The application shall document that the applicant has established referral networks to
                transfer infants requiring more sophisticated care than is available in less specialized
                facilities.


Chapter 4 – Perinatal Care                          16                             2011 State Health Plan
           5.     The application shall affirm that the applicant will record and maintain, at a minimum,
                  the following information regarding charity care and care to the medically indigent and
                  make it available to the Mississippi State Department of Health within 15 business
                  days of request:

                     a. source of patient referral;

                     b. utilization data e.g., number of indigent admissions, number of charity
                        admissions, and inpatient days of care;

                     c. demographic/patient origin data;

                     d. cost/charges data; and

                     e. any other data pertaining directly or indirectly to the utilization of services by
                        medically indigent or charity patients which the Department may request.

           6.     The applicant shall document that within the scope of its available services, neither the
                  facility nor its participating staff shall have policies or procedures which would
                  exclude patients because of race, age, sex, ethnicity, or ability to pay.


  104.03        Neonatal Special Care Services Bed Need Methodology

      The determination of need for neonatal special care beds/services in each Perinatal Planning
      Area will be based on four (4) beds per 1,000 live births as defined below.

           1.     One (1) neonatal intensive care bed per 1,000 live births in the most recent 12-month
                  reporting period.

           2.     Three (3) neonatal intermediate care beds per 1,000 live births in the most recent 12-
                  month reporting period.




2011 State Health Plan                                17                          Chapter 4 – Perinatal Care
                                              Table 4-4
                                    Neonatal Special Care Bed Need
                                                 2011

         Perinatal                                    Neonatal Intensive        Neonatal Intermediate
     Planning Areas          Number Live Births1       Care Bed Need               Care Bed Need
    PPA I                       3,878                         4                          12
    PPA II                      5,133                         5                          15
    PPA III                     2,706                         3                           8
    PPA IV                      3,210                         3                          10
    PPA V                      11,980                       12                           36
    PPA VI                      2,713                         3                           8
    PPA VII                     2,918                         3                           9
    PPA VIII                    5,689                         6                          17
    PPA IX                      5,909                         6                          18
    State Total                44,136                       45                          132
     1
      2008 Occurrence Data
     Sources: Mississippi State Department of Health, Division of Licensure and Certification; and Division of
     Health Planning and Resource Development Calculations, 2010

     Source: Bureau of Public Health Statistics




Chapter 4 – Perinatal Care                           18                               2011 State Health Plan
       GUIDELINES FOR THE
  OPERATION OF PERINATAL UNITS
(OBSTETRICS AND NEWBORN NURSERY)
105 Guidelines for the Operation of Perinatal Units (Obstetrics and Newborn Nursery)

  105.01        Organization

   Obstetrics and newborn nursery services shall be under the direction of a member of the staff of
   physicians who has been duly appointed for this service and who has experience in maternity and
   newborn care.

   There shall be a qualified professional registered nurse responsible at all times for the nursing care
   of maternity patients and newborn infants.

   Provisions shall be made for pre-employment and annual health examinations for all personnel on
   this service.

   Physical facilities for perinatal care in hospitals shall be conducive to care that meets the normal
   physiologic and psychosocial needs of mothers, neonates and their families. The facilities provide
   for deviations from the norm consistent with professionally recognized standards/guidelines.

   The obstetrical service should have facilities for the following components:

      1.        Antepartum care and testing
      2.        Fetal diagnostic services
      3.        Admission/observation/waiting
      4.        Labor
      5.        Delivery/cesarean birth
      6.        Newborn nursery
      7.        Newborn intensive care (Specialty and Subspecialty care only)
      8.        Recovery and postpartum care
      9.        Visitation

  105.02        Staffing

   The facility is staffed to meet its patient care commitments consistent with professionally
   recognized guidelines. There must be a registered nurse immediately available for direct patient
   care.

  105.03        Levels of Care (Map 4-3 shows locations of hospitals by levels of care)

                Basic Care-Level 1

           1.      Surveillance and care of all patients admitted to the obstetric service, with an
                   established triage system for identifying high-risk patients who should be transferred to
                   a facility that provides specialty or sub-specialty care

           2.      Proper detection and supportive care of unanticipated maternal-fetal problems that
                   occur during labor and delivery




2011 State Health Plan                                  21                         Chapter 4 - Perinatal Care
          3.   Capability to begin an emergency cesarean delivery within 30 minutes of the decision
               to do so
          4.   Availability of blood bank services on a 24-hour basis
          5.   Availability of anesthesia, radiology, ultrasound, and laboratory services available on a
               24-hour basis
          6.   Care of postpartum conditions
          7.   Evaluation of the condition of healthy neonates and continuing care of these neonates
               until their discharge
          8.   Resuscitation and stabilization of all neonates born in hospital
          9.   Stabilization of small or ill neonates before transfer to a specialty or sub-specialty
               facility
        10.    Consultation and transfer agreement
        11.    Nursery care
        12.    Parent-sibling-neonate visitation
        13.    Data collection and retrieval

        14.    Quality improvement programs, maximizing patient safety


Specialty Care-Level 2

          1.   Performance of basic care services as described above

          2.   Care of high-risk mothers and fetuses both admitted and transferred from other
               facilities
          3.   Stabilization of ill newborns prior to transfer
          4.   Treatment of moderately ill larger preterm and term newborns


Sub-specialty Care-Level 3

          1.   Provision of comprehensive perinatal care services for both admitted and transferred
               mothers and neonates of all risk categories, including basic and specialty care services
               as described above

          2.   Evaluation of new technologies and therapies

          3.   Maternal and neonate transport.

          4.   Training of health-care providers




Chapter 4 – Perinatal Care                           22                             2011 State Health Plan
  105.04 Perinatal Care Services

  Antepartum Care

      There should be policies for the care of pregnant patients with obstetric, medical, or surgical
      complications and for maternal transfer.

  Intra-partum Services: Labor and Delivery

      Intra-partum care should be both personalized and comprehensive for the mother and fetus.
      There should be written policies and procedures in regard to:

          1.   Assessment
          2.   Admission
          3.   Medical records (including complete prenatal history and physical)
          4.   Consent forms
          5.   Management of labor including assessment of fetal well-being:
                a. Term patient
                b. Preterm patients
                c. Premature rupture of membranes
                d. Preeclampsia/eclampsia
                e. Third trimester hemorrhage
                f. Pregnancy Induced Hypertension (PIH)
          6.     Patient receiving oxytocics or tocolytics
          7.     Patients with stillbirths and miscarriages
          8.     Pain control during labor and delivery
          9.     Management of delivery
         10.     Emergency cesarean delivery (capability within 30 minutes)
         11.     Assessment of fetal maturity prior to repeat cesarean delivery or induction of labor
         12.     Vaginal birth after cesarean delivery
         13.     Assessment and care of neonate in the delivery room
         14.     Infection control in the obstetric and newborn areas
         15.     A delivery room shall be kept that will indicate:
                   a.    The name of the patient
                   b.    Date of delivery
                   c.    Sex of infant
                   d.    Apgar
                   e.    Weight



2011 State Health Plan                               23                        Chapter 4 - Perinatal Care
                   f.        Name of physician
                   g.        Name of person assisting
                   h.        What complications, if any, occurred
                   i.        Type of anesthesia used
                   j.        Name of person administering anesthesia
        16.      Maternal transfer
        17.      immediate postpartum/recovery care
        18.      Housekeeping

  Newborn Care

       There shall be policies and procedures for providing care of the neonate including:
          1.   Immediate stabilization period
          2.   Neonate identification and security
          3.   Assessment of neonatal risks
          4.   Cord blood, Coombs, and serology testing
          5.   Eye care
          6.   Subsequent care
          7.   Administration of Vitamin K
          8.   Neonatal screening
          9.   Circumcision
        10.    Parent education
        11.    Visitation
        12.    Admission of neonates born outside of facility
        13.    Housekeeping
        14.    Care of or stabilization and transfer of high-risk neonates

  Postpartum Care

       There shall be policies and procedures for postpartum care of mother:
          1.    Assessment
          2.   Subsequent care (bed rest, ambulation, diet, care of the vulva, care of the bowel and
               bladder functions, bathing, care of the breasts, temperature elevation)
          3.   Postpartum sterilization
          4.   Immunization: RHIG and Rubella
          5.   Discharge planning
   Source: Guidelines for Perinatal Care, Second, Fourth, and Sixth Editions, American Academy of
   Pediatrics and the American College of Obstetricians and Gynecologists, 1988, 1992, and 2007.


Chapter 4 – Perinatal Care                              24                       2011 State Health Plan
                                       Map 4-2
                         Mississippi Hospitals with Obstetrical
                          and Newborn Services – All Levels




2011 State Health Plan                      25                    Chapter 4 - Perinatal Care
                                                     Map X - 3
                                            Perinatal Map 4-3 Areas
                                                        Planning Areas
                                               Perinatal Planning


                                                             De Soto                 Marshall        Benton                   Alcorn
                                                                                                                                           Tisho-
                                                                                                                                           mingo
                                                    Tunica
                                                                           Tate                                                 Prentiss
                                                                                                                 Tippah
                                                                                                       Union
                                                              Panola               Lafayette                                 Lee
                                                                                                                                      Itawamba
                                                                       I                      II        Pontotoc

                                   Coahoma
                                                    Quitman             Yalobusha
                                Bolivar
                                                                                              Calhoun         Chickasaw       Monroe
                                                   Tallahatchie
                                                                               Grenada                                             IV
                                                                                                                     Clay
                                                                                              Webster
                                                                  Carroll         Mont-
                                                                                  gomery
                    Washington                                                                                   Oktibbeha
                                                  Leflore
                                   Sunflower
                                                                                              Choctaw                              Lowndes
                                        Humphreys                                                           Winston          Noxubee
                                                                                     Attala
                                                              III
                     Issa-                                     Holmes
                    quena                 Yazoo                                      Leake              Neshoba            Kemper
                                                                     Madison
                              Sharkey


                                 Warren                                           Scott                 Newton            Lauderdale
                                                  Hinds
                                                                                                        VI
                                             V                  Rankin                    Smith         Jasper
                                                                                                                           Clarke
                      Claiborne
                                   Copiah                  Simpson


                  Jefferson
                                                                                                                   Wayne
                                                                               Covington Jones
                                        Lincoln
           Adams Franklin

                                                       Lawrence
                                                                       Jefferson
                                                                           Davis
                                                                                                    VIII
                                                                                                  Forrest   Perry            Greene
                                  Amite      Pike                 Marion
                                                                                   Lamar


      Wilkinson
                          VII
                                                          Walthall

                                                                                   Pearl River                             George
                                                                                                            Stone


                                                                                                      Harrison
                                                                                                                             Jackson
                                                                                     Hancock
                                                                                                        IX




Chapter 4 – Perinatal Care                                                  26                                               2011 State Health Plan
     CHAPTER 5
ACUTE CARE FACILITIES
    AND SERVICES
.
Chapter 5 Acute Care
Mississippi had 95 non-federal medical/surgical hospitals in FY 2009, with a total of 10,942 licensed
acute care beds (plus 145 beds held in abeyance by the MSDH). This total excludes one rehabilitation
hospital with acute care beds, one OB/GYN hospital, and Delta Regional Medical Center-West
Campus which is licensed as an acute care hospital but is used primarily for other purposes. This
total also excludes long term acute care (LTAC), rehabilitation, psychiatric, chemical dependency,
and other special purpose beds. In addition, numerous facilities provide specific health care services
on an outpatient basis. Some of these facilities are freestanding; others are closely affiliated with
hospitals. Such facilities offer an increasingly wider range of services, many of which were once
available only in inpatient acute care settings. Examples include diagnostic imaging, therapeutic
radiation, and ambulatory surgery.


100 General Medical/Surgical Hospitals

   The 95 acute care medical/surgical hospitals reported 9,959 beds set up and staffed during 2009,
   or 91.02 percent of the total licensed bed capacity. Based on beds set up and staffed, the hospitals
   experienced an overall occupancy rate of 49.29 percent and an average length of stay of 4.48 days.
   When calculating the occupancy rate using total licensed bed capacity, the overall occupancy rate
   drops to 44.87 percent. Using these statistics and 2010 projected population totals, Mississippi had
   a licensed bed capacity to population ratio of 3.68 per 1,000 and an occupied bed to population
   ratio of 1.65 per 1,000. Table 5-1 shows the licensed Mississippi hospital beds by service areas.

   These statistics indicate an average daily census in Mississippi hospitals of 4,604.37, leaving
   approximately 6,338 unused licensed beds on any given day. Sixty-eight of the state's hospitals
   reported occupancy rates of less than 40 percent during FY 2009.

   Mississippi requires Certificate of Need (CON) review for all projects that increase the bed
   complement of a health care facility or exceed a capital expenditure threshold of $2 million. The
   law requires CON review regardless of capital expenditure for the construction, development, or
   other establishment of a new health care facility, including a replacement facility; the relocation of
   a health care facility or any portion of the facility which does not involve a capital expenditure and
   is more than 5,280 feet from the main entrance of the facility; and a change of ownership of an
   existing health care facility, unless the MSDH receives proper notification at least 30 days in
   advance. A health care facility that has ceased to treat patients for a period of 60 months or more
   must receive CON approval prior to reopening. A CON is required for major medical equipment
   purchase if the capital expenditure exceeds $1.5 million and is not a replacement of existing
   medical equipment.

   A statewide glut of licensed acute care beds complicates planning for community hospital
   services. There are far more hospital beds than needed. The average use of licensed beds has been
   less than 50 percent in recent years. With few exceptions, the surplus is statewide. The continued
   presence of surplus hospital beds in all planning districts, and in nearly all counties with acute care
   hospitals, raises a number of basic planning questions:

        Does the ―carrying cost‖ of maintaining unused beds raise operating cost unnecessarily?
        Do the surpluses, and any associated economic burdens, retard the introduction of new and
        more cost effective practices and services?
        Do existing services providers maintain unwarranted surpluses to shield themselves from
        competition, as argued by some potential competitors?
2011 State Health Plan                               1                            Chapter 5 – Acute Care
        Should the space allocated to surplus beds be converted to other uses, particularly if doing so
        would avoid construction of new space, or facilities, to accommodate growing outpatient
        caseloads?
        Do the large surpluses mask need for additional services and capacity in some regions and
        reduce the sensitivity and responsiveness of planners and regulators to these legitimate
        community needs?
        Do the continuing surpluses, and the view of them by stakeholders and other interested
        parties, create an environment that invites policy intervention by legislators and other
        responsible parties?

   These questions are unusually difficult to answer definitively. That they arise not infrequently
   suggest the importance of reducing excess capacity where it is possible to do so and is not likely to
   result in problematic consequences. The Department urges each hospital to voluntarily reduce the
   licensed bed capacity to equal its average daily census plus a confidence factor that will assure that
   an unused hospital bed will be available on any given day.




Chapter 5 – Acute Care                              2                             2011 State Health Plan
                                             Table 5-1
                    Licensed Short-Term Acute Care Hospital Beds by Service Area
                                             FY 2009

                                                      Licensed Abeyance Average Daily Occupancy Average Length
Facility                                                Beds     Beds      Census       Rate        of Stay
            General Hospital Service Area 1               502    18        227.67         45.35        4.28
Alliance Healthcare System - Holly Springs                 40     0          5.90         14.75        3.22
Baptist Memorial Hospital - DeSoto                        309     0        191.03         61.82        4.44
North Oak Regional Medical Center - Senatobia              76     0         13.51         17.78        3.58
Tri-Lakes Medical Center - Batesville                      77    18         17.24         22.38        3.69
            General Hospital Service Area 2             1,059    25        491.06         46.37        4.40
Baptist Memorial Hospital - Booneville                    114     0         12.98         11.39        3.90
Baptist Memorial Hospital - Union County                  153     0         38.74         25.32        3.48
Iuka Hospital - Iuka                                       48     0         13.84         28.82        4.00
Magnolia Regional Health Center - Corinth                 145     0         91.78         63.30        4.43
North Miss Medical Center - Tupelo                        554     0        320.97         57.94        4.63
Pontotoc Health Services - Pontotoc                        25     0          5.17         20.69        3.50
Tippah County Hospital - Ripley                            20    25          7.58         37.92        3.57
            General Hospital Service Area 3               921     0        348.88         37.88        4.15
Bolivar Medical Center - Cleveland                        165     0         50.65         30.69        3.87
Delta Regional Medical Center (Main) - Greenville         227     0        100.59         44.31        4.85
Greenwood Leflore Hospital - Greenwood                    188     0         89.38         47.54        4.28
Patient's Choice Medical Center of Humphreys County        34     0          4.46         13.12        2.81
North Sunflower County Hospital                            35     0          4.90         13.99        3.43
Northwest Miss Regional Medical Center-Clarksdale         181     0         70.69         39.05        4.05
Quitman County Hospital - Marks                            33     0          8.77         26.58        3.68
South Sunflower County Hospital                            49     0         17.37         35.45        2.92
Tallahatchie General Hospital & ECF                         9     0          2.08         23.07        3.95
            General Hospital Service Area 4             1,233    35        419.62         34.03        4.21
Baptist Memorial Hospital - North Miss - Oxford           204     0        118.03         57.86        4.84
Baptist Memorial Hospital-Golden Triangle                 285     0         88.92         31.20        4.71
Calhoun Health Services - Calhoun City                     30     0          5.56         18.52        3.97
Choctaw County Medical Center                              25     0          4.12         16.46        1.94
Gilmore Memorial Hospital, Inc.                            95     0         42.04         44.25        3.82
Grenada Lake Medical Center                               156     0         41.21         26.42        4.48
Kilmichael Hospital                                        19     0          3.69         19.44        3.41
North Mississippi Medical Center-West Point                60     0         22.16         36.93        3.26
Noxubee General Critical Access Hospital                   25     0          8.23         32.93        3.40
Oktibbeha County Hospital                                  96     0         33.01         34.39        3.80
Pioneer Community Hospital of Aberdeen                     35     0          3.47          9.90        3.17
Trace Regional Hospital                                    84     0          8.56         10.20        3.31
Tyler Holmes Memorial Hospital                             25     0          5.87         23.48        3.76
Webster Health Services                                    38     0         19.53         51.38        4.46
Winston Medical Center                                     30    35          5.56         18.53        4.02
Yalobusha General Hospital                                 26     0          9.65         37.12        3.57




 2011 State Health Plan                                 3                         Chapter 5 – Acute Care
                                      Table 5-1 (continued)
                   Licensed Short-Term Acute Care Hospital Beds by Service Area
                                            FY 2009

                                                        Licensed   Abeyance Average Daily    Occupancy     Average
  Facilities                                              Beds       Beds      Census          Rate      Length of Stay
             General Hospital Service Area 5              3,191       10      1,472.70           46.15         4.87
  Central Mississippi Medical Center                        400        0        118.54           29.63         5.09
  Crossgates River Oaks Hospital                            134        0         48.01           35.82         4.39
  Hardy Wilson Memorial Hospital                             35        0         14.08           40.23         6.16
  Holmes County Hospital and Clinics                         25       10          4.08           16.33         3.11
  King's Daughters Hospital-Yazoo City                       35        0         12.70           36.28         3.68
  Leake Memorial Hospital - Carthage                         25        0          6.83           27.32         3.23
  Madison County Medical Center                              67        0         17.47           26.08         3.22
  Magee General Hospital                                     64        0         21.12           33.01         3.81
  Mississippi Baptist Medical Center                        541        0        251.80           46.54         5.04
  Montfort Jones Memorial Hospital                           71        0         18.31           25.79         4.66
  Patient's Choice Medical Center of Claiborne County        32        0          4.44           13.88         3.15
  Patients' Choice Medical Center of Smith County            29        0          0.00            0.00         0.00
  River Oaks Hospital                                       158        0         72.11           45.64         3.73
  River Region Health System                                261        0        109.81           42.07         4.52
  S.E. Lackey Critical Access Hospital                       35        0         10.90           31.15         2.64
  Scott Regional Hospital                                    25        0         11.44           45.75         3.27
  Sharkey - Issaquena Community Hospital                     29        0          7.14           24.62         4.96
  Simpson General Hospital                                   35        0          6.59           18.83         3.30
  St. Dominic-Jackson Memorial Hospital                     417        0        285.22           68.40         4.57
  University Hospital & Health System                       664        0        427.32           64.36         6.27
  Woman's Hospital at River Oaks                            109        0         24.79           22.75         3.50
             General Hospital Service Area 6                925       19        344.59           37.25         4.60
  Alliance Health Center                                    88         0          0.00            0.00         0.00
  Alliance Laird Hospital - Union                           25         0         10.27           41.07         2.97
  Anderson Regional Medical Center - Meridian              260         0        153.12           58.89         5.22
  H.C. Watkins Memorial Hospital, Inc. - Quitman            25         0          6.42           25.70         3.77
  Neshoba General Hospital - Philadelphia                   82         0         11.79           14.37         3.24
  Newton Regional Hospital - Newton                         30        19          7.55           25.17         2.99
  Riley Memorial Hospital - Meridian                       120         0         38.62           32.18         4.64
  Rush Foundation Hospital - Meridian                      215         0         87.87           40.87         4.54
  Wayne General Hospital - Waynesburo                       80         0         28.95           36.19         4.32
             General Hospital Service Area 7               719         0        240.51           33.45         4.08
  Beacham Memorial Hospital                                 37         0         16.65           45.01         5.74
  Field Memorial Community Hospital                         25         0          7.65           30.59         3.37
  Franklin County Memorial Hospital                         35         0          7.59           21.70         4.19
  Jefferson County Hospital                                 30         0          5.74           19.13         3.81
  King's Daughters Medical Center - Brookhaven             122         0         35.55           29.14         3.50
  Lawrence County Hospital                                  25         0          4.37           17.48         3.45
  Natchez Community Hospital                               101         0         44.12           43.68         3.91
  Natchez Regional Medical Center                          159         0         30.63           19.26         4.39
  Southwest Miss Regional Medical Center                   160         0         79.75           49.84         4.29
  Walthall County General Hospital                          25         0          8.46           33.84         3.83

                                                               .
Chapter 5 – Acute Care                                     4                                2011 State Health Plan
                                           Table 5-1 (continued)
                        Licensed Short-Term Acute Care Hospital Beds by Service Area
                                                 FY 2009

                                                    Licensed     Abeyance   Average Daily    Occupancy   Average
Facility                                             Beds          Beds        Census          Rate    Length of Stay
          General Hospital Service Area 8            1,046          38          519.40         49.66         4.49
Covington County Hospital                               35           0            4.35         12.44         3.75
Forrest General Hospital                               400           0          246.75         61.69         4.49
Greene County Hospital                                   3           0            0.18          6.12         2.31
Jasper General Hospital                                 16           0            0.37          2.29         4.79
Jeff Davis Community Hospital - Prentiss                35           0            5.53         15.79         3.58
Marion General Hospital                                 49          30           15.70         32.05         4.33
Perry County General Hospital                           22           8            2.33         10.59         3.12
South Central Regional Medical Center                  275           0          123.65         44.96         5.12
Wesley Medical Center                                  211           0          120.54         57.13         4.11
           General Hospital Service Area 9           1,346           0          539.95         40.11         4.23
Biloxi Regional Medical Center                         153           0           68.57         44.82         4.15
Garden Park Medical Center                             130           0           47.03         36.17         3.88
George County Hospital                                  48           0           11.06         23.05         2.83
Hancock Medical Center                                  47           0           20.78         44.20         3.58
Highland Community Hospital - Picayune                  95           0           21.24         22.36         2.88
Memorial Hospital at Gulfport                          303           0          179.24         59.15         4.94
Ocean Springs Hospital                                 136           0           91.33         67.15         4.34
Pearl River Hospital & Nursing Home - Poplarville       24           0            2.42         10.09         7.21
Singing River Hospital                                 385           0           94.71         24.60         4.09
Stone County Hospital                                   25           0            3.58         14.31         3.36
TOTAL                                               10,942         145        4,604.37         42.08         4.48


  Note: Occupancy rate is calculated based on total number of licensed beds and excludes beds in abeyance. As a
  result, the occupancy rate may not equal the occupancy rate published in the 2009 Mississippi Hospital Report..

  Source: Application for Renewal of Hospital License for Calendar Year 2010; Division of Health Planning and
  Resource Development, Office of Health Policy and Planning


  101 Hospital Outpatient Services

      The following table shows the number of visits to hospital emergency rooms and hospital
      outpatient clinics in FY 2009. These statistics represent an increase over 2008's total of 3,658,585
      visits to hospital emergency rooms and outpatient clinics.




  2011 State Health Plan                                     5                              Chapter 5 – Acute Care
                                                    Table 5-2
                         Selected Data for Hospital-Based or Affiliated Outpatient Clinics
                                         by General Hospital Service Area
                                                     FY 2009
           General      Number                Number of
           Hospital      with     Number of Hospitals with Number of                           Total
           Service     Emergency Emergency    Organized    Outpatient                       Outpatient
            Area      Departments Room Visits Outpatient Clinic Visits                         Visits
          Mississippi     87       1,722,777      76       2,901,948                        4,624,725
              1            4           85,344      4           62,604                         147,948
              2            7          167,350      7          289,970                         457,320
              3            9          153,820      5          248,549                         402,369
              4           14          203,175     13          373,090                         576,265
              5           19          399,148     18          678,143                       1,077,291
              6            8          119,159      7          163,254                         282,413
              7            9          114,825      8          126,868                         241,693
              8            8          187,222      5          160,849                         348,071
              9            9          292,734      9          798,621                       1,091,355

        Source: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
        Hospital Report, Mississippi State Department of Health




Chapter 5 – Acute Care                               6                            2011 State Health Plan
ACUTE CARE
102 Certificate of Need Criteria and Standards for General Acute Care Facilities

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


  102.01 Policy Statement Regarding Certificate of Need Applications for General Acute Care
         Hospitals and General Acute Care Beds

      1.     Acute Care Hospital Need Methodology: With the exception of psychiatric, chemical
             dependency, and rehabilitation hospitals, the Mississippi State Department of Health
             (MSDH) will use the following methodologies to project the need for general acute care
             hospitals:

           a. Counties Without a Hospital - The MSDH shall determine hospital need by multiplying
              the state's average annual occupied beds (1.65 in FY 2009) per 1,000 population by the
              estimated 2010 county population to determine the number of beds the population could
              utilize. A hospital with a maximum of 100 beds may be considered for approval if: (a) the
              number of beds needed is 100 or more; (b) there is strong community support for a
              hospital; and (c) a hospital can be determined to be economically feasible.

           b. Counties With Existing Hospitals - The MSDH shall use the following formula to
              determine the need for an additional hospital in a county with an existing hospital:

                    ADC + K( ADC )

                     Where:      ADC = Average Daily Census

                                 K = Confidence Factor of 2.57

                     The formula is calculated for each facility within a given General Hospital Service
                     Area (GHSA); then beds available and beds needed under the statistical
                     application of the formula are totaled and subtracted to determine bed need or
                     excess within each GHSA. Map 5-1 delineates the GHSAs. The MSDH may
                     consider approval of a hospital with a maximum of 100 beds if: (a) the number of
                     beds needed is 100 or more; (b) there is strong community support for a hospital;
                     and (c) a hospital can be determined to be economically feasible.

           c. Counties Located in an Underdeveloped General Hospital Service Area and With a
              Rapidly Growing Population - Notwithstanding the need formula in b above, any
              county with a population in excess of 140,000 people; projecting a population growth rate
              in excess of ten (10) percent over the next ten (10) year period; and its General Hospital
              Service Area does not presently exceed a factor of three (beds per 1,000 population); may

2011 State Health Plan                                9                           Chapter 5 – Acute Care
            be considered for a new acute care hospital not to exceed one hundred (100) beds, in that
            county.

            Further, any person proposing a new hospital under criterion 1c above must meet the
            following conditions:

              1) Provide an amount of indigent care in excess of the average of the hospitals in the
                 General Hospital Service Area as determined by the State Health Officer;

              2) Provide an amount of Medicaid care in excess of the average of the hospitals in the
                 General Hospital Service Area as determined by the State Health Officer; and

              3) If the proposed hospital will be located in a county adjacent to a county or counties
                 without a hospital, the applicant must establish outpatient services in the adjacent
                 county or counties without a hospital;

              4) Fully participate in the Trauma Care System at a level to be determined by the
                 Department for a reasonable number of years to be determined by the State Health
                 Officer. Fully participate means play in the Trauma Care System as provided in
                 the Mississippi Trauma Care System Regulations and the new hospital shall not
                 choose or elect to pay a fee not to participate or participate at a level lower than the
                 level specified in the CON; and

              5) The new hospital must also participate as a network provider in the State and
                 School Employees’ Health Insurance Plan as defined in Mississippi Code Section
                 25-15-3 and 25-15-9.

      2.   Need in Counties Without a Hospital: Seven counties in Mississippi do not have a
           hospital: Amite, Benton, Carroll, Issaquena, Itawamba, Kemper, and Tunica. Most of
           these counties do not have a sufficient population base to indicate a potential need for the
           establishment of a hospital, and all appear to receive sufficient inpatient acute care
           services from hospitals in adjoining counties. (Note: Kemper County has an outstanding
           CON for a 25 bed hospital).

      3.   Expedited Review: The MSDH may consider an expedited review for Certificate of Need
           applications that address only license code deficiencies, project cost overruns, and
           relocation of facilities or services.

      4.   Capital Expenditure: For the purposes of Certificate of Need review, transactions which
           are separated in time but planned to be undertaken within 12 months of each other and
           which are components of an overall long-range plan to meet patient care objectives shall
           be reviewed in their entirety without regard to their timing. For the purposes of this policy,
           the governing board of the facility must have duly adopted the long-range plan at least 12
           months prior to the submission of the CON application.

      5.   No health care facility shall be authorized to add any beds or convert any beds to another
           category of beds without a Certificate of Need.

      6.   If a health care facility has voluntarily delicensed some of its existing bed complement, it
           may later relicense some or all of its delicensed beds without the necessity of having to
           acquire a Certificate of Need. The Department of Health shall maintain a record of the

Chapter 5 – Acute Care                              10                             2011 State Health Plan
              delicensing health care facility and its voluntarily delicensed beds and continue counting
              those beds as part of the state’s total bed count for health care planning purposes.

           7. A health care facility that has ceased to operate for a period of 60 months or more shall
              require a Certificate of Need prior to reopening.


102.02      Certificate of Need Criteria and Standards for the Establishment of a General Acute
            Care Hospital

      The Mississippi State Department of Health (MSDH) will review applications for a Certificate
      of Need to construct, develop, or otherwise establish a new hospital under the applicable
      statutory requirements of Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code of
      1972, as amended. The MSDH will also review applications for Certificate of Need according
      to the general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted
      rules, procedures, and plans of the MSDH; and the specific criteria and standards listed below.

      1.      Need Criterion: The applicant shall document a need for a general acute care
              hospital using the appropriate need methodology as presented in this section of the
              Plan. In addition, the applicant must meet the other conditions set forth in the need
              methodology.

      2.      The application shall document that the applicant will provide a "reasonable amount" of
              indigent/charity care as described in Chapter 1 of this Plan.


102.03      Certificate of Need Criteria and Standards for Construction, Renovation, Expansion,
            Capital Improvements, Replacement of Health Care Facilities, and Addition of
            Hospital Beds

      The Mississippi State Department of Health (MSDH) will review applications for a Certificate
      of Need for the addition of beds to a health care facility and projects for construction,
      renovation, expansion, or capital improvement involving a capital expenditure in excess of
      $2,000,000 under the applicable statutory requirements of Sections 41-7-173, 41-7-191, and
      41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review applications for
      Certificate of Need according to the general criteria listed in the Mississippi Certificate of Need
      Review Manual; all adopted rules, procedures, and plans of the MSDH; and the specific criteria
      and standards listed below.

      The construction, development, or other establishment of a new health care facility, the
      replacement and/or relocation of a health care facility or portion thereof, and changes of
      ownership of existing health care facilities are reviewable regardless of capital expenditure.

      3.      Need Criterion:

           a. Projects which do not involve the addition of any acute care beds: The applicant shall
              document the need for the proposed project. Documentation may consist of, but is not
              limited to, citing of licensure or regulatory code deficiencies, institutional long-term plans
              (duly adopted by the governing board), recommendations made by consultant firms, and
              deficiencies cited by accreditation agencies (JCAHO, CAP, etc.). In addition, for projects
              which involve construction, renovation, or expansion of emergency department facilities,

2011 State Health Plan                                 11                            Chapter 5 – Acute Care
              the applicant shall include a statement indicating whether the hospital will participate in
              the statewide trauma system and describe the level of participation, if any.

           b. Projects which involve the addition of beds: The applicant shall document the need for
              the proposed project. In addition to the documentation required as stated in Need
              Criterion (1)(a), the applicant shall document that the facility in question has maintained
              an occupancy rate of at least 60 percent for the most recent two (2) years or has
              maintained an occupancy rate of at least 70 percent for the most recent two (2) years
              according to the below formula:

                   # Observation patient days*/365/ licensed beds       +      Inpatient Occupancy rate

               *An observation patient is a patient that has NOT been admitted as an inpatient, but
               occupies an acute care bed (observation bed) and is provided observation services in a
               licensed, acute care hospital. Hospitals shall follow strict guidelines set forth by The
               Centers for Medicare & Medicaid Services, health insurance companies, and others in
               reporting observation bed data to the Department. For definitions that correspond with
               the above referenced item, please refer to the Glossary included in the Plan.


      4.      Bed Service Transfer/Reallocation/Relocation: Applications proposing the transfer,
              reallocation, and/or relocation of a specific category or sub-category of bed/service from
              another facility as part of a renovation, expansion, or replacement project shall document
              that the applicant will meet all regulatory/licensure requirements for the type of
              bed/service being transferred/reallocated/relocated.

      5.      Charity/Indigent Care: The application shall affirm that the applicant will provide a
              "reasonable amount" of indigent/charity care as described in Chapter 1 of this Plan.

      6.      The application shall demonstrate that the cost of the proposed project, including
              equipment, is reasonable in comparison with the cost of similar projects in the state.

           a. The applicant shall document that the cost per square foot (per bed if applicable) does not
              exceed the median construction costs, as determined by the MSDH, for similar projects in
              the state within the most recent 12-month period by more than 15 percent. The Glossary
              of this Plan provides the formulas to be used by MSDH staff in calculating the cost per
              square foot for construction and/or construction/renovation projects.

           b. If equipment costs for the project exceed the median costs for equipment of similar
              quality by more than 15 percent, the applicant shall provide justification for the excessive
              costs. The median costs shall be based on projects submitted during the most recent six-
              month period and/or estimated prices provided by acceptable vendors.

      7.      The applicant shall specify the floor areas and space requirements, including the following
              factors:

           a. The gross square footage of the proposed project in comparison to state and national
              norms for similar projects.

           b. The architectural design of the existing facility if it places restraints on the proposed
              project.

Chapter 5 – Acute Care                                 12                             2011 State Health Plan
           c. Special considerations due to local conditions.

      8.     If the cost of the proposed renovation or expansion project exceeds 85 percent of the cost
             of a replacement facility, the applicant shall document their justification for rejecting the
             option of replacing said facility.

      9. The applicant shall document the need for a specific service (i.e. perinatal, ambulatory
          care, psychiatric, etc.) using the appropriate service specific criteria as presented in this
          and other sections of the Plan.




2011 State Health Plan                                13                            Chapter 5 – Acute Care
                                   Map 5-1
                         General Hospital Service Areas
                          2010 Population Projections




Chapter 5 – Acute Care               14                   2011 State Health Plan
LONG-TERM ACUTE CARE
   HOSPITALS/BEDS
103 Long-Term Acute Care Hospitals

       A long-term acute care (LTAC) hospital is a free-standing, Medicare-certified acute care
       hospital with an average length of inpatient stay greater than 25 days that is primarily engaged
       in providing chronic or long-term medical care to patients who do not require more than three
       hours of rehabilitation or comprehensive rehabilitation per day. As of April 2010, nine long-
       term acute care hospitals were in operation. One additional facility had received Certificate of
       Need authority for 40 LTAC beds. The following table lists specific LTAC information.

                                                     Table 5-3
                                           Long-Term Acute Care Hospitals
                                                       2009
                                                               Authorized   Licensed   Occupancy
    Facility                                       Location      Beds         Beds       Rate    Discharges   ALOS
                 General Hospital Service Area 1                      0           0        0.00         0       0.00
    NONE
                 General Hospital Service Area 2                      0           0        0.00         0       0.00
    NONE
                 General Hospital Service Area 3                     80          40       55.77        308     26.09
    Delta Regional Medical Center               - Greenville         40       CON
    Greenwood Specialty Hospital             - Greenwood             40          40       55.77        308     26.09
               General Hospital Service Area 4                        0           0        0.00         0       0.00
    NONE
                 General Hospital Service Area 5                    149         149       71.91      1,580     23.82
    Mississippi Hospital for Restorative Care   - Jackson            25          25       68.35        192     26.81
    Promise Hospital of Vicksburg               - Vicksburg          35          35       73.03        358     25.30
    Regency Hospital of Jackson                  - Jackson           36          36       61.31        386     20.87
    Select Specialty Hospital of Jackson       - Jackson             53          53       80.04        644     23.88
                  General Hospital Service Area 6                    89          89       79.74        923     28.17
    Regency Hospital of Meridian                - Meridian           40          40       70.05        394     25.97
    Specialty Hospital of Meridian             - Meridian            49          49       87.64        529     29.81
                 General Hospital Service Area 7
    NONE
                 General Hospital Service Area 8                     33          33       82.61        343     27.68
    Regency Hospital of Southern Mississippi  - Hattiesburg          33          33       82.61        343     27.68
                General Hospital Service Area 9                      80          61       37.21        302     26.79
    Select Specialty Hospital-Gulfport          - Gulfport           80          61       37.21        302     26.79
    TOTAL                                                           431         372       58.09      3,456     25.83


  NOTE: There are currently no LTAC Hospitals located in GHSA 1, 2, 4, and 7.

  Source: Source: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
  Hospital Report, Mississippi State Department of Health




2011 State Health Plan                                         17                             Chapter 5– Acute Care
     104 Certificate of Need Criteria and Standards for Long-Term Acute Care
         Hospitals/Beds
        Note: Should the Mississippi State Department of Health receive a Certificate of Need application
        regarding the acquisition and/or otherwise control of major medical equipment or the provision of
        a service for which specific CON criteria and standards have not been adopted, the application
        shall be deferred until the Department of Health has developed and adopted CON criteria and
        standards. If the Department has not developed CON criteria and standards within 180 days of
        receiving a CON application, the application will be reviewed using the general CON review
        criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
        adopted rules, procedures, and plans of the Mississippi State Department of Health.


         104.01     Policy Statement Regarding Certificate of Need Applications for Long-Term
                    Acute Care Hospitals and Long-Term Acute Care Hospital Beds
1.      Restorative Care Admissions: Restorative care admissions shall be identified as patients with one
        or more of the following conditions or disabilities:

                        a. Neurological Disorders

                                i.   Head Injury

                               ii.   Spinal Cord Trauma

                              iii.   Perinatal Central Nervous System Insult

                              iv.    Neoplastic Compromise

                               v.    Brain Stem Trauma

                              vi.    Cerebral Vascular Accident

                              vii.   Chemical Brain Injuries

                        b. Central Nervous System Disorders

                                i.   Motor Neuron Diseases

                               ii.   Post Polio Status

                              iii.   Developmental Anomalies

                              iv.    Neuromuscular Diseases (e.g. Multiple Sclerosis)

                               v.    Phrenic Nerve Dysfunction

                              vi.    Amyotrophic Lateral Sclerosis




     Chapter 5 – Acute Care                               18                            2011 State Health Plan
                    c. Cardio-Pulmonary Disorders

                             i.   Obstructive Diseases

                            ii.   Adult Respiratory Distress Syndrome

                           iii.   Congestive Heart Failure

                           iv.    Respiratory Insufficiency

                            v.    Respiratory Failure

                           vi.    Restrictive Diseases

                          vii.    Broncho-Pulmonary Dysplasia

                          viii.   Post Myocardial Infarction

                           ix.    Central Hypoventilation

                    d. Pulmonary Cases

                             i.   Presently Ventilator-Dependent/Weanable

                            ii.   Totally Ventilator-Dependent/Not Weanable

                           iii.   Requires assisted or partial ventilator support

                           iv.    Tracheostomy that requires supplemental oxygen and bronchial hygiene

2.   Bed Licensure: All beds designated as long-term care hospital beds shall be licensed as general
     acute care.

3.   Average Length of Stay: Patients' average length of stay in a long-term care hospital must be 25
     days or more.

4.   Size of Facility: Establishment of a long-term care hospital shall not be for less than 20 beds.

5.   Long-Term Medical Care: A long-term acute care hospital shall provide chronic or long-term
     medical care to patients who do not require more than three (3) hours of rehabilitation or
     comprehensive rehabilitation per day.

6.   Transfer Agreement: A long-term acute care hospital shall have a transfer agreement with an
     acute care medical center and a comprehensive medical rehabilitation facility.

7.   Effective July 1, 1994, no health care facility shall be authorized to add any beds or convert any
     beds to another category of beds without a Certificate of Need under the authority of Section 41-7-
     191(1)(c), unless there is a projected need for such beds in the planning district in which the
     facility is located.




 2011 State Health Plan                                  19                         Chapter 5– Acute Care
104.02     Certificate of Need Criteria and Standards for the Establishment of a Long-Term
           Acute Care Hospital and Addition of Long-Term Acute Care Hospital Beds

      The Mississippi State Department of Health will review applications for a Certificate of Need
      for the construction, development, or otherwise establishment of a long-term acute care
      hospital and bed additions under the applicable statutory requirements of Sections 41-7-173,
      41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review
      applications for Certificate of Need according to the general criteria listed in the Mississippi
      Certificate of Need Review Manual; all adopted rules, procedures, and plans of the Mississippi
      State Department of Health; and the specific criteria and standards listed below.
      1.    Need Criterion: The applicant shall document a need for the proposed project.
            Documentation shall consist of the following:

                  a. minimum of 450 clinically appropriate restorative care admissions with an
                     average length of stay of 25 days; and

                  b. a projection of financial feasibility by the end of the third year of operation.

      2.    The applicant shall document that any beds which are constructed/converted will be
            licensed as general acute care beds offering long-term acute care hospital services.

      3.    Applicants proposing the transfer/reallocation/relocation of a specific category or sub-
            category of bed/service from another facility as part of a renovation, expansion, or
            replacement project shall document that they will meet all regulatory and licensure
            requirements for the type of bed/service proposed for transfer/reallocation/relocation.

      4.    The application shall affirm that the applicant will provide a "reasonable amount" of
            indigent/charity care as described in Chapter 1 of this Plan.

      5.    The application shall demonstrate that the cost of the proposed project, including
            equipment, is reasonable in comparison with the cost of similar projects in the state. The
            applicant shall document that the cost per square foot (per bed if applicable) does not
            exceed the median construction costs, as determined by the MSDH, for similar projects in
            the state within the most recent 12-month period by more than 15 percent. The Glossary of
            this Plan provides the formulas MSDH staff shall use to calculate the cost per square foot
            of space for construction and/or construction-renovation projects.

      6.    The applicant shall specify the floor areas and space requirements, including the following
            factors:

                  a. The gross square footage of the proposed project in comparison to state and
                     national norms for similar projects.
                  b. The architectural design of the existing facility if it places restraints on the
                     proposed project.
                  c. Special considerations due to local conditions.
      7.    The applicant shall provide copies of transfer agreements entered into with an acute care
            medical center and a comprehensive medical rehabilitation facility.




Chapter 5 – Acute Care                               20                              2011 State Health Plan
SWING-BED SERVICES
105 Swing-Bed Programs and Extended Care Services

      Federal law allows hospitals of up to 100 beds to use designated beds as ―swing beds‖ to
      alternate between acute and extended care. Patients occupy swing-beds for a few days to
      several weeks. Hospitals must meet several requirements for certification as swing-beds under
      Medicare and Medicaid. Federal certification requirements focus on eligibility, skilled nursing
      facility services, and coverage requirements. Eligibility criteria include rural location, fewer
      than 100 beds, a Certificate of Need, and no waiver of the 24-hour nursing requirement.

      In addition to meeting acute care standards, swing-bed hospitals must also meet six standards
      for nursing facility services. These standards involve patients' rights, dental services,
      specialized rehabilitative services, social services, patient activities, and discharge planning.
      Swing-bed hospitals have the same Medicare coverage requirements and coinsurance
      provisions as nursing facilities. Many patients, particularly elderly patients, no longer need
      acute hospital care but are not well enough to go home. Swing-beds enable the hospital to
      provide nursing care, rehabilitation, and social services with a goal of returning patients to their
      homes. Many of these patients would become nursing home residents without the extended
      period of care received in a swing-bed.

      Swing-beds provide a link between inpatient acute care and home or community-based services
      in a continuum of care for the elderly and others with long-term needs. If return to the
      community is not possible, the swing-bed hospital assists the patient and family with nursing
      home placement. The swing-bed concept may help alleviate the problem of low utilization in
      small rural hospitals and provide a new source of revenue with few additional expenses.
      Additionally, swing-beds allow hospitals to better utilize staff during periods of low occupancy
      in acute care beds.


105.01 Swing-Bed Utilization

          The fifty-four Mississippi hospitals and one specialty hospital participated in the swing bed
          program. During Fiscal Year 2009, they reported 6,869 discharges from their swing beds,
          with 92,734 patient days of care and an average length of stay of 13.71 days. The number of
          days of care provided in swing beds was equivalent to approximately 254 nursing home
          beds.

          The swing-bed program offers a viable alternative to placement in a nursing home for short-
          term convalescence. During the year, only about 11.6 percent of the patients who were
          discharged from a swing-bed went to a nursing home; 70.4 percent went home, 35.7 percent
          were referred to home health, eight percent were readmitted to a hospital; and 7.9 or 8
          percent were referred to a personal care home.




2011 State Health Plan                              23                             Chapter 5– Acute Care
                                                   Table 5-4
                                              Swing Bed Utilization
                                                    FY 2009

                                                            Licensed                          Average Daily
       Facility                                               Beds         Discharges    ALOS    Census
       General Hospital Service Area 1                                 4          16       7.13             0.25
       Alliance Health Care System                                     4          16       7.13             0.25
       General Hospital Service Area 2                                67          629      9.42            16.04
       Baptist Memorial Hospital-Booneville                           10          260      8.55             5.88
       Baptist Memorial Hospital-Union County                      12               12     6.00             0.20
       North MS Medical Center-Iuka                                10              130    11.68             4.16
       Pontotoc Critical Access Hospital                           25              182     9.65             4.83
       Tippah County Hospital                                      10               45     7.89             0.97
       General Hospital Service Area 3                             68              650    13.78            24.38
       North Sunflower Medical Center                              15              313    13.09            11.10
       Patients Choice Med. Ctr. of Humphreys County               25              195    14.93             7.79
       Quitman County Hospital                                     25              106    11.58             3.43
       Tallahatchie General Hospital & ECF                          3               36    19.94             2.05
       General Hospital Service Area 4                            163            1,592    13.06            56.36
       Calhoun Health Services                                     10               59    14.56             2.58
       Choctaw County Medical Center                                4               47    13.40             1.61
       Gilmore Memorial Regional Medical Center                    16              175     7.31             3.74
       Kilmichael Hospital                                         10               19    22.84             1.23
       North Mississippi Medical Center-West Point                 10              268     8.32             6.13
       Noxubee General Critical Access Hospital                    25              110    21.25             5.45
       Oktibbeha County Hospital                                   10                7     8.14             0.15
       Pioneer Community Hospital                                  25              186    19.79             9.96
       Trace Regional Hospital                                     10              112     6.06             1.86
       Tyler Holmes Memorial Hospital                              10              184    10.67             5.69
       Webster Health Services                                     10              193    15.21             7.67
       Winston Medical Center                                      10               84    12.19             2.72
       Yalobusha General Hospital                                  13              148    18.07             7.57
       General Hospital Service Area 5                            171            1,706    13.50            62.13
       Hardy Wilson Memorial Hospital                              10             132     15.42             5.56
       King's Daughters Hospital-Yazoo City                        25             139     13.50             5.15
       Leake Memorial Hospital                                     10             103     13.03             3.67
       Madison County Medical Center                               10              55     21.91             3.22
       Magee General Hospital                                      12             351     12.01            11.36
       Monfort Jones Memorial Hospital                             12             127     12.34             4.25
       Patient's Choice of Claiborne County                         7             180     15.13             7.45
       S.E. Lackey Critical Access Hospital                        15             159     14.08             6.13
       Scott Regional Hospital                                     10             156     11.28             4.51
       Sharkey-Issaquena Community Hospital                        10              43     14.79             1.62
       Simpson General Hospital                                    25             155     12.51             5.51
       University Hospital Clinics-Holmes County                   25             106     14.07             3.68




Chapter 5 – Acute Care                                 24                         2011 State Health Plan
                                             Table 5-4 (Continued)
                                             Swing Bed Utilization
                                                   FY 2009

                                                         Licensed                                Average Daily
     Facility                                              Beds        Discharges     ALOS          Census
     General Hospital Service Area 6                             120          834        12.75           30.52
     Alliance-Laird Hospital                                      25           180       10.42            4.94
     H.C. Watkins Memorial Hospital                               25           214       10.98            8.21
     Neshoba County General Hospital                              10           151       10.28            4.08
     Netwon Regional Hospital                                     30            25        9.52            0.65
     Specialty Hospital of Meridian                               20           117       16.80            5.63
     Wayne General Hospital                                       10           147       18.01            7.00
     General Hospital Service Area 7                              50           537       13.32           19.77
     Beacham Memorial Hospital                                    15          197        12.24            6.65
     Field Memorial Community Hospital                            10          155        11.26            4.72
     Franklin County Memorial Hospital                            10           44         9.93            1.23
     Walthall County General Hospital                             15          141        18.14            7.17
     General Hospital Service Area 8                              77           518       17.58           25.60
     Covington County Medical Center                              10           132       17.17            6.56
     Greene County Hospital                                        3            36       17.64            1.74
     Jasper General Hospital                                      12            85       20.76            4.58
     Jeff Davis Community Hospital                                10           85        13.20            3.49
     Marion General Hospital                                      20            96       15.29            4.25
     Perry County General Hospital                                22            84       22.00            4.98
     Ganeral Hospital Service Area 9                              45           367       22.43           19.01
     George County Hospital                                       10            34       13.50            1.23
     Pearl River Hospital & Nursing Home                          10            92       37.89            6.66
     Stone County Hospital                                        25           241       17.78           11.12
     State Total                                                 765        6,849        13.71          254.07

    Source: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual
    Hospital Report, Mississippi State Department of Health




2011 State Health Plan                              25                               Chapter 5– Acute Care
105.02     Certificate of Need Criteria and Standards for Swing-Bed Services

      The Mississippi State Department of Health will review applications for a Certificate of Need
      (CON) to establish swing-bed services under the applicable statutory requirements of Sections
      41-7-173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will
      also review applications for CON according to the general criteria listed in the Mississippi
      Certificate of Need Review Manual; all adopted rules, procedures, and plans of the MSDH; and
      the specific criteria and standards listed below.

      1.    Need Criterion: The application shall document that the hospital will meet all
            federal regulations regarding the swing-bed concept. However, a hospital may have
            more licensed beds or a higher average daily census (ADC) than the maximum number
            specified in federal regulations for participation in the swing-bed program.
      2.    The applicant shall provide a copy of the Resolution adopted by its governing board
            approving the proposed participation.
      3.    If the applicant proposes to operate and staff more than the maximum number of beds
            specified in federal regulations for participation in the swing-bed program, the application
            shall give written assurance that only private pay patients will receive swing-bed services.
      4.    The application shall affirm that upon receiving CON approval and meeting all federal
            requirements for participation in the swing-bed program, the applicant shall render
            services provided under the swing-bed concept to any patient eligible for Medicare (Title
            XVIII of the Social Security Act) who is certified by a physician to need such services.
      5.    The application shall affirm that upon receiving CON approval and meeting all federal
            requirements for participation in the swing-bed program, the applicant shall not permit
            any patient who is eligible for both Medicaid and Medicare or is eligible only for
            Medicaid to stay in the swing-beds of a hospital for more than 30 days per admission
            unless the hospital receives prior approval for such patient from the Division of Medicaid.
      6.    The application shall affirm that if the hospital has more licensed beds or a higher average
            daily census than the maximum number specified in federal regulations for participation in
            the swing-bed program, the applicant will develop a procedure to ensure that, before a
            patient is allowed to stay in the swing-beds of the hospital, there are no vacant nursing
            home beds available within a 50-mile radius (geographic area) of the hospital. The
            applicant shall also affirm that if the hospital has a patient staying in the swing-beds of the
            hospital and the hospital receives notice from a nursing home located within a 50-mile
            radius that there is a vacant bed available for that patient, the hospital shall transfer the
            swing-bed patient to the nursing home within five days, exclusive of holidays and
            weekends, unless the patient's physician certifies that the transfer is not medically
            appropriate.
      7.    The applicant shall provide copies of transfer agreements entered into with each nursing
            facility within the applicant's geographic area.

      8.    An applicant subject to the conditions stated in Criterion #5 shall affirm in the application
            that they will be subject to suspension from participation in the swing-bed program for a
            reasonable period of time by the Department of Health if the Department, after a hearing
            complying with due process, determines that the hospital has failed to comply with any of
            those requirements.




Chapter 5 – Acute Care                               26                             2011 State Health Plan
THERAPEUTIC RADIATION SERVICES
106 Therapeutic Radiation Services

   Therapeutic radiology (also called radiation oncology, megavoltage radiotherapy, or radiation
   therapy) is the treatment of cancer and other diseases with radiation. Radiation therapy uses high
   energy light beams (x-ray or gamma rays) or charged particles (electron beams or photon beams)
   to damage critical biological molecules in tumor cells. Radiation in various forms is used to kill
   cancer cells by preventing them from multiplying. Therapeutic radiation may be used to cure or
   control cancer, or to alleviate some of the symptoms associated with cancer (palliative care).

   In radiation therapy, a non-invasive treatment can be given repetitively over several weeks to
   months and can be aimed specifically at the area where treatment is needed, minimizing side
   effects for uninvolved normal tissues. This repetitive treatment is called fractionation because a
   small fraction of the total dose is given each treatment. Radiotherapy can only be performed with
   linear accelerator (linac) technology. Conventionally administrated external beam radiation
   therapy gives a uniform dose of radiation to the entire region of the body affected by the tumor.
   Only a small variation of the dose is delivered to various parts of the tumor. Radiotherapy may not
   be as effective as stereotactic radiosurgery, which can give higher doses of radiation to the tumor
   itself.

   Another type of radiation therapy used in Mississippi is brachytherapy. Unlike the external beam
   therapy, in which high-energy beams are generated by a machine and directed at a tumor from
   outside the body, brachytherapy involves placing a radioactive material directly into the body.
   Brachytherapy radiation implantation was performed on 722 patients in 17 of the state’s hospitals
   during FY 2009.


107 Stereotactic Radiosurgery

   Despite its name, stereotactic radiosurgery is a non-surgical procedure that uses highly focused x-
   rays (or in some cases, gamma rays) to treat certain types of tumors, inoperable lesions, and as a
   post-operative treatment to eliminate any leftover tumor tissue. Stereotactic radiosurgery treatment
   involves the delivery of a single high-dose – or in some cases, smaller multiple doses – of
   radiation beams that converge on the specific area of the brain where the tumor or other
   abnormality resides.

   Stereotactic radiosurgery was once limited to the GammaKnife® for treating intra-cranial lesions
   and functional issues. With the introduction of CyberKnife® and other LINAC-based radiosurgery
   systems, there has been rapid growth in total-body radiosurgery. The modified LINAC
   radiosurgery modality is now being used to treat lung, liver, pancreas, prostate, and other body
   areas. Some modified full-body LINAC models use full-body frames as a guiding tool and others
   do not. Therefore, the term ―stereotactic radiosurgery‖ will refer to radiosurgery regardless of
   whether a full-body frame is used or not. A full course of radiosurgery requires only one to five
   treatments versus 30 to 40 for radiotherapy.

   Three basic types of stereotactic radiosurgery are in common use, each of which uses different
   instruments and sources of radiation:

   Cobalt 60 Based (Gamma Knife), which uses 201 beams of highly focused gamma rays.
   Because of its incredible accuracy, the Gamma Knife is ideal for treating small to medium size
   lesions.



2011 State Health Plan                             29                            Chapter 5– Acute Care
        Linear accelerator (LINAC) based machines, prevalent throughout the world, deliver high-
        energy x-ray photons or electrons in curving paths around the patient’s head. The linear
        accelerator can perform radiosurgery on larger tumors in a single session or during multiple
        sessions (fractionated stereotactic radiotherapy). Multiple manufacturers make linear
        accelerator machines, which have names such as: Axess®, Clinac®, Cyberknife®, Novalis®,
        Peacock®, TomoTherapy®, Trilogy®, or X-Knife®. According to Accuray, the
        CyberKnife® is the world’s only robotic radiosurgery system designed to treat tumors
        anywhere in the body non-invasively and with sub-millimeter accuracy.

        Particle beam (photon) or cyclotron based machines are in limited use in North America.

        Table 5-5 presents the facilities offering megavoltage therapeutic radiation therapy.


108 Diagnostic Imaging Services

   Diagnostic imaging equipment and services, except for magnetic resonance imaging, positron
   emission tomography, and invasive digital angiography, are reviewable under the state's
   Certificate of Need law only when the capital expenditure for the acquisition of the equipment and
   related costs exceeds $1.5 million. The provision of invasive diagnostic imaging services, i.e.,
   invasive digital angiography, positron emission tomography, and the provision of magnetic
   resonance imaging services require a Certificate of Need if the proposed provider has not offered
   the services on a regular basis within 12 months prior to the time the services would be offered,
   regardless of the capital expenditure.

   Equipment in this category includes, but is not limited to: ultrasound, diagnostic nuclear
   medicine, digital radiography, angiography equipment, computed tomographic scanning
   equipment, magnetic resonance imaging equipment, and positron emission tomography.




Chapter 5 – Acute Care                             30                            2011 State Health Plan
                                                   Table 5-5
                        Facilities Reporting Megavoltage Therapeutic Radiation Services
                                        by General Hospital Service Area
                                              FY 2008 and FY 2009

                                                                                               Number of
                         Facility                      Number and Type of Unit              Treatments (Visits)
                                                                                              2008         2009
                       General Hospital Service Area 1                                         7,413        7,682
  Baptist Memorial Hospital - DeSoto      1 - Lin-Acc (6-18MV)                                 7,413        7,682
                       General Hospital Service Area 2                                        17,345       16,722
  Magnolia Regional Health Center         1 - Lin-Acc (6-18MV)                                 4,652        4,573
  North Miss Medical Center               2 - Lin-Acc (6MV & 18MV)                            12,693       12,149
                          General Hospital Service Area 3                                     14,046       14,765
  Bethesda Cancer Center1                    1 - Lin-Acc (6MV)                                 2,625        2,270
                        1                    2 - Lin-Acc (6-18MV)
  Delta Cancer Institute                                                                       5,293        4,192
                                       1     1 - Lin-Acc (6MV)
  North Central Regional Cancer Center                                                         6,128        8,303
                          General Hospital Service Area 4                                     21,110       23,421
  Baptist Memorial Hospital - Golden         1 - Lin-Acc (6MV & 18MV)                         15,597       18,129
  Baptist Cancer Institute - North Miss      1 Lin-Acc (6-18MV)                                5,513        5,292
                                        1    1 - Lin-Acc (6 & 18MV)
  Cancer Care at Premier Health Complex                                                          -          CON
                          General Hospital Service Area 5                                     46,578       51,002
  Cancer Center of Vicksburg1                1 - Lin-Acc (6-15MV)                              4,539        5,127
  Central Miss Medical Center              2 - Lin-Acc (6MV & 18MV)                           12,345       12,727
  Miss Baptist Medical Center              2 - Lin-Acc (6-18MV)                               12,156       14,063
  St. Dominic Hospital                     2 - Lin-Acc (6-18MV)                               10,129       10,435
  University Hospital & Clinics            2 - Lin-Acc (6-18MV)                                7,409        8,650
                        General Hospital Service Area 6                                       10,119       10,478
  Anderson Regional Cancer Center          2 - Lin-Acc (6 & 25MV, 4 &10MV)                    10,119       10,478
                         General Hospital Service Area 7                                       9,754       10,604
                             1              1 - Lin-Acc (6-18MV)
  Caring River Cancer Center                                                                   4,227        5,121
  Southwest Miss Regional Medical Center    1 - Lin-Acc (6-18MV)                               5,527        5,483
                         General Hospital Service Area 8                                      15,943       18,377
  Forrest General Hospital                  2 - Lin-Acc (6-15MV)                              13,527       14,987
                                   1        1 - Lin-Acc (6 & 10MV)
  South Central Miss Cancer Center                                                             2,416        3,390
                        General Hospital Service Area 9                                       16,069       15,735
  Biloxi Radiation Oncology Center1        1 - Lin-Acc (6MV)                                   2,762        1,097
                                        1          1 Lin-Acc (6 & 18MV)
  Cedar Lake Oncology Center                                                                     -         2,653
  Memorial Hospital at Gulfport                    2 - Lin-Acc (6-18 & 15MV)                   7,905       6,184
  Singing River Hospital                           1 - Lin-Acc (6-18MV)                        5,402       5,801
  State Total                                                                                158,377     168,786
  1
      Indicates freestanding clinics.

  Sources: Applications for Renewal of Hospital License for Calendar Years 2009 and 2010; and Fiscal Years 2008 and
  2009 Annual Hospital Reports




2011 State Health Plan                                     31                                Chapter 5– Acute Care
109 Certificate of Need Criteria and Standards for Therapeutic Radiation Services

      Note: Should the Mississippi State Department of Health receive a Certificate of Need
      application regarding the acquisition and/or otherwise control of major medical equipment or
      the provision of a service for which specific CON criteria and standards have not been adopted,
      the application shall be deferred until the Department of Health has developed and adopted
      CON criteria and standards. If the Department has not developed CON criteria and standards
      within 180 days of receiving a CON application, the application will be reviewed using the
      general CON review criteria and standards presented in the Mississippi Certificate of Need
      Review Manual and all adopted rules, procedures, and plans of the Mississippi State
      Department of Health.


  109.01 Policy Statement Regarding Certificate of Need Applications for the Acquisition or
         Otherwise Control of Therapeutic Radiation Equipment, and/or the Offering of
         Therapeutic Radiation Services (other than Stereotactic Radiosurgery)

      1.   Service Areas: The Mississippi State Department of Health shall determine the need for
           therapeutic radiation services/units/equipment by using the General Hospital Service
           Areas as presented in this chapter of the Plan. The MSDH shall determine the need for
           therapeutic radiation services/units/equipment within a given service area independently
           of all other service areas. Map 5-1 shows the General Hospital Service Areas.

      2.   Equipment to Population Ratio: The need for therapeutic radiation units (as defined) is
           determined to be one unit per 147,659 population (see methodology in this section of the
           Plan). The MSDH will consider out-of-state population in determining need only when
           the applicant submits adequate documentation acceptable to the Mississippi State
           Department of Health, such as valid patient origin studies.

      3.   Limitation of New Services: When the therapeutic radiation unit-to-population ratio
           reaches one to 147,659 in a given general hospital service area, no new therapeutic
           radiation services may be approved unless the utilization of all the existing machines in a
           given hospital service area averaged 8,000 treatments or 320 patients per year for the two
           most recent consecutive years as reported on the "Renewal of Hospital License and
           Annual Hospital Report." For the purposes of this policy Cesium-137 teletherapy units,
           Cobalt-60 teletherapy units designed for use at less than 80 cm SSD (source to skin
           distance), old betatrons and van de Graaf Generators, unsuitable for modern clinical use,
           shall not be counted in the inventory of therapeutic radiation units located in a hospital
           service area.

      4.   Expansion of Existing Services: The MSDH may consider a CON application for the
           acquisition or otherwise control of an additional therapeutic radiation unit by an existing
           provider of such services when the applicant's existing equipment has exceeded the
           expected level of patient service, i.e., 320 patients per year or 8,000 treatments per year
           for the two most recent consecutive years as reported on the facility's "Renewal of
           Hospital License and Annual Hospital Report."

      5.   Equipment Designated for Backup: Therapeutic radiation equipment designated by an
           applicant as "backup" equipment shall not be counted in the inventory for CON purposes.




Chapter 5 – Acute Care                             32                             2011 State Health Plan
            Any treatments performed on the "backup" equipment shall be attributed to the primary
            equipment for CON purposes.

      6.    Definition of a Treatment: For health planning and CON purposes a patient "treatment" is
            defined as one individual receiving radiation therapy during a visit to a facility which
            provides megavoltage radiation therapy regardless of the complexity of the treatment or
            the number of "fields" treated during the visit.

      7.    Use of Equipment or Provision of Service: Before the equipment or service can be
            utilized or provided, the applicant desiring to provide the therapeutic radiation equipment
            or service shall have CON approval or written evidence that the equipment or service is
            exempt from CON approval, as determined by the Mississippi State Department of Health.


109.02     Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control
           of Therapeutic Radiation Equipment and/or the Offering of Therapeutic Radiation
           Services (other than Stereotactic Radiosurgery)

  The Mississippi State Department of Health will review Certificate of Need applications for the
  acquisition or otherwise control of therapeutic radiation equipment and/or the offering of
  therapeutic radiation services under the applicable statutory requirements of Sections 41-7-173, 41-
  7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review
  applications for Certificate of Need according to the general criteria listed in the Mississippi
  Certificate of Need Review Manual; all adopted rules, procedures, and plans of the Mississippi State
  Department of Health; and the specific criteria and standards listed below.

  The acquisition or otherwise control of therapeutic radiation equipment is reviewable if the
  equipment cost exceeds $1,500,000. The offering of therapeutic radiation services is reviewable if
  the proposed provider has not provided those services on a regular basis within the period of twelve
  (12) months prior to the time such services would be offered.

  1. Need Criterion: The applicant shall document a need for therapeutic radiation
     equipment/service by complying with any one of the following methodologies:

              a.   the need methodology as presented in this section of the Plan;

              b.   demonstrating that all existing machines in the service area in question have
                   averaged 8,000 treatments per year or all machines have treated an average of
                   320 patients per year for the two most recent consecutive years; or

              c.   demonstrating that the applicant’s existing therapeutic equipment has
                   exceeded the expected level of patients service, i.e., 320 patients per year/unit,
                   or 8,000 treatments per year/unit for the most recent 24-month period.

  2. The applicant must document that access to diagnostic X-ray, CT scan, and ultrasound services
     is readily available within 15 minutes normal driving time of the therapeutic radiation unit's
     location.

  3. An applicant shall document the following:

      a.    The service will have, at a minimum, the following full-time dedicated staff:



2011 State Health Plan                              33                           Chapter 5– Acute Care
                  i.     One board-certified radiation oncologist-in-chief

                 ii.     One dosimetrist

                iii.     One certified radiation therapy technologist certified by the American Registry of
                         Radiation Technologists

                iv.      One registered nurse

      b.      The service will have, at a minimum, access to a radiation physicist certified or eligible
              for certification by the American Board of Radiology.

              Note: One individual may act in several capacities. However, the application shall affirm
              that when a staff person acts in more than one capacity, that staff person shall meet, at a
              minimum, the requirements for each of the positions they fill.

  4. The applicant shall affirm that access will be available as needed to brachytherapy staff,
     treatment aides, social workers, dietitians, and physical therapists.

  5. Applicants shall document that all physicians who are responsible for therapeutic radiation
     services in a facility, including the radiation oncologist-in-chief, shall reside within 60 minutes
     normal driving time of the facility.

  6. The application shall affirm that the applicant will have access to a modern simulator capable
     of precisely producing the geometric relationships of the treatment equipment to a patient. This
     simulator must produce high quality diagnostic radiographs. The applicant shall also affirm that
     the following conditions will be met as regards the use of the simulator:

           a. If the simulator is located at a site other than where the therapeutic radiation equipment is
              located, protocols will be established which will guarantee that the radiation oncologist
              who performs the patient's simulation will also be the same radiation oncologist who
              performs the treatments on the patient.

           b. If the simulator uses fluoroscopy, protocols will be established to ensure that the
              personnel performing the fluoroscopy have received appropriate training in the required
              techniques related to simulation procedures.

                      Note: X-rays produced by diagnostic X-ray equipment and photon beams produced
                      by megavoltage therapy units are unsuitable for precise imaging of anatomic
                      structures within the treatment volume and do not adequately substitute for a
                      simulator.

  7. The application shall affirm that the applicant will have access to a computerized treatment
     planning system with the capability of simulation of multiple external beams, display isodose
     distributions in more than one plane, and perform dose calculations for brachytherapy implants.

                      Note: It is highly desirable that the system have the capability of performing CT
                      based treatment planning.

  8. The applicant shall affirm that all treatments will be under the control of a board certified or
     board eligible radiation oncologist.



Chapter 5 – Acute Care                                   34                           2011 State Health Plan
  9. The applicant shall affirm that the proposed site, plans, and equipment shall receive approval
     from the MSDH Division of Radiological Health before service begins.

  10. The application shall affirm that the applicant will establish a quality assurance program for the
      service, as follows:

        a. The therapeutic radiation program shall meet, at a minimum, the physical aspects of
           quality assurance guidelines established by the American College of Radiology (ACR)
           within 12 months of initiation of the service.

        b. The service shall establish a quality assurance program which meets, at a minimum, the
           standards established by the American College of Radiology.

  11. The applicant shall affirm understanding and agreement that failure to comply with criterion
      #10 (a) and (b) may result in revocation of the CON (after due process) and subsequent
      termination of authority to provide therapeutic radiation services.


  109.02.01 Therapeutic Radiation Equipment/Service Need Methodology

             1. Treatment/Patient Load: A realistic treatment/patient load for a therapeutic radiation
                unit is 8,000 treatments or 320 patients per year.

             2. Incidence of Cancer: The American Cancer Society (ACS) estimates that Mississippi
                will experience 14,330 new cancer cases in 2010 (excluding basal and squamous cell
                skin cancers and in-situ carcinomas except urinary bladder cancer). Based on a
                population of 2,975,551 (year 2010) as estimated by the Center for Policy Research
                and Planning, the cancer rate of Mississippi is 4.82 cases per 1,000 population.

             3. Patients to Receive Treatment: The number of cancer patients expected to receive
                therapeutic radiation treatment is set at 45 percent.

             4. Population to Equipment Ratio: Using the above stated data, a population of 100,000
                will generate 482 new cancer cases each year. Assuming that 45 percent will receive
                radiation therapy, a population of 147,659 will generate approximately 320 patients
                who will require radiation therapy. Therefore, a population of 147,659 will generate a
                need for one therapeutic radiation unit.


  109.02.02 Therapeutic Radiation Equipment Need Determination Formula

             1. Project annual number of cancer patients.

                   General Hospital Service                  4.82 cases*
                   Area Population               X        1,000 population = New Cancer Cases

                   *Mississippi cancer incidence rate

             2. Project the annual number of radiation therapy patients.

                   New Cancer Cases X 45% = Patients Who Will Likely Require Radiation Therapy



2011 State Health Plan                               35                           Chapter 5– Acute Care
             3. Estimate number of treatments to be performed annually.

                   Radiation Therapy Patients X 25 Treatments per Patient (Avg.) = Estimated
                   Number of Treatments

             4. Project number of megavoltage radiation therapy units needed.

                      Est. # of Treatments =      Projected Number of Units Needed
                   8,000 Treatments per Unit

             5. Determine unmet need (if any) Projected Number of Units Needed — Number of
                Existing Units = Number of Units Required (Excess)


109.03     Policy Statement Regarding Certificate of Need Applications for the Acquisition or
           Otherwise Control of Stereotactic Radiosurgery Equipment and/or the Offering of
           Stereotactic Radiosurgery.

      1.    Service Areas: The Mississippi State Department of Health shall determine the need for
            stereotactic radiosurgery services/units/equipment by using the actual stereotactic
            radiosurgery provider’s service area.

      2.    Equipment to Population Ratio: The need for stereotactic radiosurgery units is determined
            to be the same as for radiotherapy, for 2010, a population of 147,659. The therapeutic
            radiation need determination formula is outlined in Section 109.02.02 above.

      3.    Accessibility: Nothing contained in these CON criteria and standards shall preclude the
            University of Mississippi School of Medicine from acquiring and operating stereotactic
            radiosurgery equipment, provided the acquisition and use of such equipment is justified by
            the School's teaching and/or research mission. However, the requirements listed under the
            section regarding the granting of "appropriate scope of privileges for access to the
            stereotactic radiosurgery equipment to any qualified physician" must be met.

      4.    Expansion of Existing Services: The MSDH may consider a CON application for the
            acquisition or otherwise control of an additional stereotactic radiosurgery unit by an
            existing provider of such services when the applicant's existing equipment has exceeded
            the expected level of patient service, i.e., 900 treatments per year for the two most recent
            consecutive years as reported on the facility's "Renewal of Hospital License and Annual
            Hospital Report."

      5.    Facilities requesting approval to add stereotactic radiosurgery services should have an
            established neurosurgery program and must be able to demonstrate previous radiosurgery
            service experience.

      6.    All stereotactic radiosurgery services should have written procedures and policies for
            discharge planning and follow-up care for the patient and family as part of the institution's
            overall discharge planning program.

      7.    All stereotactic radiosurgery services should have established protocols for referring
            physicians to assure adequate post-operative diagnostic evaluation for radiosurgery
            patients.



Chapter 5 – Acute Care                               36                            2011 State Health Plan
      8.      The total cost of providing stereotactic radiosurgery services projected by prospective
              providers should be comparable to the cost of other similar services provided in the state.

      9.      The usual and customary charge to the patient for stereotactic radiosurgery should be
              commensurate with cost.


109.04      Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control
            of Stereotactic Radiosurgery Equipment and/or the Offering of Stereotactic
            Radiosurgery

      The Mississippi State Department of Health will review Certificate of Need applications for the
      acquisition or otherwise control of stereotactic radiosurgery equipment and/or the offering of
      stereotactic radiosurgery services under the applicable statutory requirements of Sections 41-7-
      173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also
      review applications for Certificate of Need according to the general criteria listed in the
      Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of the
      Mississippi State Department of Health; and the specific criteria and standards listed below.

      The acquisition or otherwise control of stereotactic radiosurgery equipment is reviewable if the
      equipment cost exceeds $1,500,000. The offering of stereotactic radiosurgery services is
      reviewable if the proposed provider has not provided those services on a regular basis within
      the period of twelve (12) months prior to the time such services would be offered.

      1.      Need Criterion: The applicant shall document a need for stereotactic radiosurgery
              equipment/service by reasonably projecting that the proposed new service will
              perform at least 900 stereotactic radiosurgery treatments in the third year of
              operation. No additional new stereotactic radiosurgery services should be approved
              unless the number of stereotactic radiosurgery treatments performed with existing
              units in the state average 900 treatments or more per year.

      2.      Staffing:

           a. The radiosurgery programs must be established under the medical direction of two co-
              directors, one with specialty training and board certification in neurosurgery and the other
              with specialty training and board certification in radiation oncology, with experience in all
              phases of stereotactic radiosurgery.

           b. In addition to the medical co-directors, all stereotactic radiosurgery programs should have
              a radiation physicist who is certified in radiology, or who holds an advanced degree in
              physics with two to three years experience working under the direction of a radiation
              oncologist, and a registered nurse present for each stereotactic radiosurgery performed.

           c. The applicant shall document that the governing body of the entity offering stereotactic
              radiosurgery services will grant an appropriate scope of privileges for access to the
              stereotactic radiosurgery equipment to any qualified physician who applies for privileges.
              For the purpose of this criterion, "Qualified Physician" means a doctor of medicine or
              osteopathic medicine licensed by the State of Mississippi who possesses training in
              stereotactic radiosurgery and other qualifications established by the governing body.




2011 State Health Plan                                37                            Chapter 5– Acute Care
      3.   Equipment:

            a. Facilities providing stereotactic radiosurgery services should have dosimetry and
               calibration equipment and a computer with the appropriate software for performing
               stereotactic radiosurgery.

             b. The facility providing stereotactic radiosurgery services should also have access to
                magnetic resonance imaging, computed tomography, and angiography services




Chapter 5 – Acute Care                             38                            2011 State Health Plan
DIAGNOSTIC IMAGING SERVICES
110 Computed Tomographic (CT) Scanning

      Should the capital expenditure for the acquisition of fixed or mobile CT scanning services,
      equipment, and related costs exceed $1.5 million, the CON proposal will be reviewed under the
      general review criteria outlined in the most recent Certificate of Need Review Manual adopted
      by the Mississippi State Department of Health and the following utilization standards:

             A proposed unit must be able to generate a minimum of 2,000 HECTs (See Table 5-6 for
             HECT conversion table) by the second year of operation.

             Providers desiring CT capability must be properly utilizing 20,000 general radiographic
             imaging procedures per year.

                                           Table 5-6
                           Head Equivalent Conversion Table (HECT)


                                           Yearly Number
     Type of Scan                                        Conversion Factor           HECTs*
                                             of Patients
     Head without Contrast                              500                 1.00           500
     Head with Contrast                                 500                 1.25           625
     Head with and without Contrast                     200                 1.75           350
     Body without Contrast                              100                 1.50           150
     Body with Contrast                                 200                 1.75           350
     Body with and without Contrast                     300                 2.75           825
      * Formula: Yearly Number of Patients X Conversion Factor = HECTs


    110.01       Magnetic Resonance Imaging (MRI)

      Magnetic resonance imaging (MRI) is a diagnostic imaging technique that employs magnetic
      and radio-frequency fields to produce images of the body non-invasively. Magnetic resonance
      imaging is similar to CT scanning in that it produces cross-sectional and digital images without
      potentially harmful ionizing radiation, producing an image not distorted by bone mass. The
      equipment and its operational specifications continue to be refined.

      Ninety-eight facilities (hospitals and free-standing) in Mississippi operated fixed or mobile
      based MRI units in FY 2009. These facilities performed a total of 259,369 MRI procedures
      during the year. Table 5-7 presents the location, type (fixed or mobile and number of units per
      facility), and utilization of MRI equipment throughout the state in 2008 and 2009.




2011 State Health Plan                             41                           Chapter 5– Acute Care
                                                     Table 5-7
                        Location and Number of MRI Procedures by General Hospital Service Area
                                                FY 2008 and FY 2009

                                                                                                          Number of MRI
                                                    Type of                                   Type of                         Days/Hours of Operation
                                                                      City          County                  Procedures
                                                   Providers                                 Equipment
                                                                                                         2008         2,009            2009
                                         General Hospital Service Area 1                                  15,132     15,418
    Baptist Memorial Hospital - DeSoto                H        Southaven      DeSoto           F(3)        7,481      7,902     Sun.-Sat., 168 Hrs.
    Carvel Imaging Center                             FS       Olive Branch   DeSoto            F          2,556      2,336       M-F, 40 + Hrs.
    Carvel Imaging Center                             FS       Southaven      DeSoto            F          2,076      2,229       M-F, 40+ Hrs.
    Desoto Imaging Specialists                        FS       Southaven      DeSoto            M          1,908      2,083    Tu., W, & F, 27 Hrs.
    P&L Contracting 1                                 MP       Batesville     Panola            M           817        477        M & Tu.,8 Hrs.
    Scan This, LLC                                    MP       Senathobia     Tate              M              -      CON              N/A
    Tri-Lakes Medical Center                          H        Batesville     Panola            M           294        391          Tu., 4 Hrs.
                                         General Hospital Service Area 2                                  31,918     32,036
    Baptist Memorial Hospital - Booneville            H        Booneville     Prentiss          F           884        824         M-F, 40 Hrs
    Baptist Memorial Hospital - Union                 H        New Albany     Union             F          2,282      2,426        M-F, 60 Hrs.
    Imaging Center of Gloster Creek Village           FS       Tupelo         Lee               F          3,530      3,117        M-F, 60 Hrs.
    Magnolia Regional Health Center                   H        Corinth        Alcorn           F(2)        5,541      6,115    M-Su, M-F- 110 Hrs.
    Medical Imaging at Barnes Crossing                FS       Tupelo         Lee               F          2,057      3,128        M-F 54 Hrs.
    Medical Imaging at Crossover Road                 FS       Tupelo         Lee               F          2,394      2,107        M-F, 40 Hrs.
    North Miss. Medical Center                        H        Tupelo         Lee              F(4)       13,885     13,085   M-Su. & M-F, 240 Hrs.
    North Miss. Medical Center - Iuka                 H        Iuka           Tishomingo        M           981        884         M-F, 40 Hrs.
    North Mississippi Sports Medicine                 FS       Tupelo         Lee               F           364        350         M-F, 40 Hrs.
                                         General Hospital Service Area 3                                  11,755     11,228
    Bolivar Medical Center                            H        Cleveland      Bolivar           M          1,435      1,439        M-F, 40 Hrs.
    Delta Regional Med. Center                        H        Greenville     Washington        F          2,718      3,205        M-F, 40 Hrs.
    Greenwood Leflore Hospital                        H        Greenwood      Leflore           F          4,245      4,115        M-F, 60 Hrs.
    Northwest Miss. Regional Medical Center           H        Clarksdale     Coahoma           M          2,439      1,704        M-F, 50 Hrs.
    P&LC-North Sunflower Medical Center 1             MP       Ruleville      Sunflower         M           164        235          Tu., 4 Hrs.
    P&LC-Quitman County Hospital 1                    MP       Marks          Quitman           M            26           -         Th., 3 Hrs.
    South Sunflower County Hospital                   H        Indianola      Sunflower         M           728        530          W, 4 Hrs.
                                         General Hospital Service Area 4                                  24,783     21,518
    Baptist Mem. Hospital - Golden Triangle           H        Columbus       Lowndes          F(2)        3,350      3,028       M-F, 100 Hrs.
    Baptist Memorial Hospital - North Miss            H        Oxford         Lafayette         F          4,403      2,695      M-F, 140 + Hrs.
    Calhoun Health Services                           H        Calhoun City   Calhoun           M           273        222      Tu. & Thr., 8 Hrs.
    Gilmore Memorial Hospital, Inc.                   H        Amory          Monroe            M          1,253      1,168        M-F, 40 Hrs.
    Grenada Lake Medical Center                       H        Grenada        Grenada           F          2,968      2,742        M-F, 40 Hrs.
    Imaging Center of Columbus                        FS       Columbus       Lowndes          F(2)        4,815      5,089       M-F, 120 Hrs.
    Imaging Ctr. of Excellence Institute - MSU        FS       Starkville     Oktibbeha         F          1,686       795         M-F, 40 Hrs.
    North Miss. Medical Center - Eupora               H        Eupora         Webster           M           920        998         M-F, 32 Hrs.
    North Miss. Medical Center - West Point           H        West Point     Clay              M           739        631         M-F, 40 Hrs.
    Oktibbeha County Hospital                         H        Starkville     Oktibbeha         F          2,604      2,501       M-F, 40 Hrs.
    Pioneer Community Hospital                        H        Aberdeen       Monroe            M           499        456         M-F, 16 Hrs.
    Trace Regional Hospital                           H        Houston        Chickasaw         M           387        470          Th., 8 Hrs.
    Tyler Holmes Memorial Hospital                    H        Winona         Montgomery        M           385        326        W a.m., 4 Hrs.
    Yalobusha Hospital                                H        Water Valley   Yalobusha         M           501        397          M, 4 Hrs.


F – Fixed Unit
M – Mobile Unit
Type of Providers: H-Hospital, FS-Freestanding, and MP-Mobile Provider
1
    P&L Contracting,, Inc. is the approved service provider.
2
    Scott Medical Imaging is the approved service provider.




Chapter 5 – Acute Care                                                        42                                   2011 State Health Plan
                                         Table 5-7 (continued)
                 Location and Number of MRI Procedures by General Hospital Service Area
                                         FY 2008 and FY 2009

                                                                                                 Number of MRI
                                             Type of                                  Type of                          Days/Hours of Operation
                  Facility                                   City        County                    Procedures
                                            Providers                                Equipment
                                                                                                 2008       2009                 2009
                                 General Hospital Service Area 5                                 78,654     80,938
Central Miss. Diagnostics                      FS       Jackson        Hinds            F          2,529     2,503          M-F, 45 Hrs.
Central Miss. Medical Center                    H       Jackson        Hinds         F(1) M(1)     5,763     5,574         M-F, 50+ Hrs.
Crossgates River Oaks Hosp.-Rankin MC           H       Brandon        Rankin           F          1,989     2,072 M-F, 40 Hrs., 24/7 On Call
Hardy Wilson Hospital                           H       Hazlehurst     Copiah           M           130          363      M-AM & W-PM
King's Daughters Medical Center                 H       Yazoo City     Yazoo            M           110          519         Tu., 4 Hrs.
Kosciusko Medical Clinic 3                     FS       Kosciusko      Attala           F          2,164     2,113         M-F, 30 Hrs.
Madison Medical Imaging, LLC                   FS       Madison        Madison          F          2,265     2,260         M-F, 40 Hrs.
Madison Radiological Group, LLC                FS       Madison        Madison          F          2,012     2,103         M-F, 40 Hrs.
Magee General Hospital                          H       Magee          Simpson          F          1,106     1,093         M-F, 40 Hrs.
Miss. Baptist Medical Center                    H       Jackson        Hinds           F(2)        7,767     8,305       M-Sat., M-F, 104 Hrs.
Miss. Diagnostic Imaging Center                FS       Flowood        Rankin          F(2)        5,718     5,149        M-F, 104 Hrs.
Miss. Sports Medicine & Orthopedic             FS       Jackson        Hinds           F(2)        3,455     3,736         M-F, 100 Hrs.
Monfort Jones Memorial Hospital 3               H       Kosciusko      Attala                       364          253       M-F, 50 Hrs.
Open MRI of Jackson                            FS       Flowood        Rankin           F          1,523     1,574         M-F, 45 Hrs.
Ridgeland Diagnostic Center                    FS       Ridgeland      Madison          M           321          324      M & W, 8 Hrs.
River Oaks Hospital                             H       Flowood        Rankin           F          4,702     5,903         M-F, 40 Hrs.
River Region Health System                      H       Vicksburg      Warren           F          2,752     3,155         M-F, 56 Hrs.
SE Lackey Memorial Hospital                     H       Forrest        Scott            M           727          634      W & F, 16 Hrs.
Scott Regional Hospital                         H       Morton         Scott            M           262          197           F-AM
Sharkey/Issaquena Hospital                      H       Rolling Fork   Sharkey          M           176          131         W, 4 hrs.
Southern Diagnostic Imaging                    FS       Flowood        Rankin          F(2)        5,092     5,711         M-F, 80 Hrs.
SMI Leake Memorial Hospital 2                  MP       Carthage       Leake            M           310          279         Tu., 4 Hrs.
SMI-Madison Specialty Clinic 2                 MP       Canton         Madison          M           475          358     Tu. & Th., 8 Hrs.
SMI-Simpson General Hospital 2                 MP       Mendenhall     Simpson          M           102          154          Th.-PM
St. Dominic Hospital                            H       Jackson        Hinds         F(3)/M(1)    13,480    13,018        M-F, 195 Hrs.
University Hospital & Clinics                   H       Jackson        Hinds           F(5)       11,833    11,955        M-F, S 294 Hrs.
University Hospital Clinics                     H       Lexington      Holmes           M           520          473         M, 8 Hrs.
Vicksburg Diagnostic Imaging                   FS       Vicksburg      Warren           M          1,007     1,029         M-F, 40 Hrs.
                                 General Hospital Service Area 6                                 17,172     16,996
Anderson Regional Medcial Center                H       Meridian       Lauderdale       F               -     CON               N/A
H. C. Watkins Memorial Hospital                 H       Quitman        Clarke           M           296          336     Tu. & Thr., 8 Hrs.
Laird Hospital                                  H       Union          Newton           M           875          699     M,W, & F, 24 Hrs.
Neshoba General Hospital*                       H       Philadelphia   Neshoba          M           258      1,563        M-Sat., 48 Hrs.
Newton Regional Hospital                        H       Newton         Newton           M           149          156          M-AM
Orthopaedic Imaging Associates, LLC            FS       Meridian       Lauderdale       M           863          709     Tu. & Th., 16 Hrs.
Regional Medical Support Center, Inc. 4        FS       Meridian       Lauderdale      F(3)       8,229      7,076        M-F, 120 Hrs.
Rush Medical Group 5                           FS       Meridian       Lauderdale      F(2)       6,192      6,143        M-F, 140 Hrs.
Wayne County Hospital                           H       Waynesboro     Wayne            M           310          314          M-PM


F – Fixed Unit
M – Mobile Unit
Type of Providers: H-Hospital, FS-Freestanding, and MP-Mobile Provider
2
  Scott Medical Imaging is the approved service provider
3
  Monfont Jones Memorial Hospital shares a fixed unit with Kosciusko Medical Clinic.
4
  Regional Medical Support Center, Inc. performs MRIs for Anderson Regional Medical Center, Riley Memorial
Hospital, & Rush Foundation Hospital.
5
  Rush Medical Group performs MRIs for Rush Foundation Hospital.
* Neshoba General Hospital- Hospital reported MRI correction in April 2010 as 1,560 MRI Scans for FY 2008.
2011 State Health Plan                                                          43                               Chapter 5– Acute Care
                                          Table 5-7(continued)
                  Location and Number of MRI Procedures by General Hospital Service Area
                                          FY 2008 and FY 2009

                                                                                                                      Number of MRI
                                                         Type of                                          Type of                            Days/Hours of Operation
                         Facility                                              City         County                      Procedures
                                                        Providers                                        Equipment
                                                                                                                     2007         2009                   2009
                                           General Hospital Service Area 7                                            7,537         7,804
    King's Daughters Medical Center                         H       Brookhaven             Lincoln          M          1,179        1,436         M-F, = 40 Hrs.
    Open Air of Miss Lou-Natchez Reg. M.C.                 FS       Natchez                Adams           F(2)        2,968        2,997          M-F, 80 Hrs.
    SMI-Lawrence County Hospital 2                         MP       Monticello             Lawrence         M           117          136              W-PM
    SMI - Walthall County Hospital 2                       MP       Tylertown              Walthall         M           240          177             W, 4 Hrs.
    Southwest MS Regional Medical Center                    H       McComb                 Pike             F          3,033        3,058         M-F, 75 Hrs.
                                           General Hospital Service Area 8                                           34,868        36,328
    Forrest General Hospital                                H       Hattiesburg            Forrest         F(2)        5,410        5,526        M-Sat., 136 Hrs.
    Hattiesburg Clinic, P.A.                               FS       Hattiesburg            Forrest        F(3) M       8,975       10,817   Su.-Sat. & M-F-105 & 145 Hrs.

    Jefferson Davis Comm. Hospital 6                       MP       Prentiss               Jeff Davis       M           163          206            Th., 4 Hrs.
    Open Air MRI of Laurel                                 FS       Laurel                 Jones            F          5,133        5,123          M-F, 60 Hrs.
    SMI - Marion General Hospital 2                        MP       Columbia               Marion           M           452          404            Tu., 8 Hrs.
    South Central Regional Medical Center                   H       Laurel                 Jones            F          2,124        2,075          M-F, 50 Hrs.
    Southern Bone & Joint Specialist, PA                   FS       Hattiesburg            Forrest         F(2)        6,512        6,431       M-Sat., 140 Hrs.
    Southern Medical Imaging                               FS       Hattiesburg            Forrest          F          2,016        2,001          M-F, 40 Hrs.
    Wesley Medical Center                                   H       Hattiesburg            Lamar            F          4,083        3,745          M-F, 50 Hrs.
                                           General Hospital Service Area 9                                           36,983        37,103
    Biloxi Regional Medical Center                          H       Biloxi                 Harrison         F          5,301        4,951      Sun.-Sun., 50+ Hrs.
    Coastal County Imaging Services                        FS       Gulfport               Harrison         F          1,515        1,730        M& F, 45 Hrs.
    Garden Park Medical Center                              H       Gulfport               Harrison         F          2,333        2,290          M-F, 60 Hrs.
    George County Hospital                                  H       Lucedale               George           F           807          747           M-F, 40 Hrs.
    Hancock Medical Center                                  H       Bay St. Louis          Hancock          F          1,309        1,348          M-F, 40 Hrs.
    Highland Community Hospital                             H       Picayune               Pearl River      M          1,017        1,131          M,F- 40 Hrs.
    Memorial Hospital at Gulfport                           H       Gulfport               Harrison        F(2)        5,424        6,024         M-F, 150 Hrs.
    Ocean Springs Hospital                                  H       Ocean S./OS Img Ctr. Jackson           F (2)       4,112        3,860         M-F, 130 Hrs.
    Open MRI - Cedar Lake                                  FS       Gulfport               Harrison         F          3,936        2,980          M-F, 45 Hrs.
    Open MRI - Compass Site                                FS       Gulfport               Harrison         F          4,681        4,634          M-F, 70 Hrs.
    OMRI, Inc. dba Open MRI                                MP       Ocean S./Pasg.         Jackson         M(2)        1,992        2,610          M-F, 80 Hrs.
    Singing River Hospital                                  H       Pascagoula             Jackson       F(1) M(1)     4,556        4,798         M-F, 98 + Hrs.
    State Total                                                                                                      258,938      259,369


F – Fixed Unit
M – Mobile Unit
Type of Providers: H-Hospital, FS-Freestanding, and MP-Mobile Provider
2
    Scott Medical Imaging is the approved service provider.
6
    Comprehensive Radiology Services, PLLC fka Hattiesburg Radiology Group, PLLC is the approved service provider

Sources: Applications for Renewal of Hospital License for Calendar Years 2009 and 2010; Fiscal Year 2008 and 2009
Annual Hospital Reports; FY 2008 and FY 2009 MRI Utilization Survey




Chapter 5 – Acute Care                                                                44                                       2011 State Health Plan
111 Digital Subtraction Angiography (DSA)

      Digital Subtraction Angiography (DSA) is a diagnostic imaging procedure that combines a
      digital processing unit with equipment similar to that used for standard fluoroscopic
      procedures. A radiopaque dye is injected into the patient; a computer then compares the pre-
      injection and post-injection images and subtracts any interfering bone and tissue structures
      obscuring the arteries. The X-ray pictures are converted to a digital form, which can be
      electronically manipulated and stored. Through the electronic manipulation, the images can be
      enhanced and further refined to give detailed information about the patient's vascular anatomy
      without additional X-ray exposure.

      In some cases, the use of DSA may eliminate the need for arterial catheterization, which many
      times carries a higher risk factor. Because the digital method is more sensitive to contrast
      materials, a lesser amount is generally needed in a given area, and intravenous injection of
      contrast may be sufficient. When required, intra-arterial injection can be done using less
      contrast per study.

      Due to its relative safety and good patient acceptance, DSA may be performed on a repeat
      basis in cases where risk and cost of conventional angiography might otherwise preclude a
      series of follow-up studies. Such studies can provide valuable information regarding the natural
      history of a variety of vascular diseases and the long-term results of various therapeutic
      interventions. DSA also allows safer screening of the elderly, who have a high risk of
      cerebrovascular disease.

      Most DSA studies can be performed in less than one hour and are appropriate as an outpatient
      procedure, whereas conventional angiography usually requires a hospital stay of one or two
      days. Twenty-three hospitals and one freestanding facility in the state provide DSA. During
      2009, 53,779 procedures were reported.

      DSA equipment performs several types of procedures. These procedures include examination
      of the carotid arteries, intracranial arteries, renal arteries, aortic arch, and peripheral leg
      arteries. A variety of anatomical and functional studies of the heart and coronary arteries are
      also performed.

      Table 5-8 presents DSA utilization throughout the state in 2009.




2011 State Health Plan                             45                            Chapter 5– Acute Care
                                                        Table 5-8
                                   Digital Subtraction Angiography (DSA) Utilization
                                                        FY 2009

                                                                                                          DSA
          County                              Facilities                                 City          Procedures
                                                                                                          2009
                                     General Hospital Service Area 1                                         1,851
    DeSoto              Baptist Memorial Hospital - DeSoto                        Southaven                      10
    DeSoto              DeSoto Imaging Specialists1                               Southaven                  1,841
                                     General Hospital Service Area 2                                         8,206
    Alcorn              Magnolia Regional Medical Center                          Corinth                      157
    Lee                 North Mississippi Medical Center                          Tupelo                     8,049
                                     General Hospital Service Area 3                                         3,211
    Bolivar             Bolivar Medical Center                                    Cleveland                    283
    Leflore             Greenwood Leflore Hospital                                Greenwood                  2,162
    Washington          Delta Regional Medical Center                             Greenville                   766
                                     General Hospital Service Area 4                                         5,172
    Lafayette           Baptist Memorial Hospital - North Mississippi             Oxford                       463
    Lowndes             Baptist Memorial Hospital- Golden Triangle                Columbus                   4,709
                                     General Hospital Service Area 5                                        27,338
    Hinds               Central Mississippi Medical Center                        Jackson                    2,245
    Hinds               Mississippi Baptist Medical Center                        Jackson                    2,487
    Hinds               St. Dominic Jackson Memorial Hospital                     Jackson                    8,953
    Hinds               University Hospital & Health System                       Jackson                   13,291
    Rankin              Crossgates River Oaks Hospital (Rankin MC)                Brandon                      362
                                     General Hospital Service Area 6                                         3,008
    Lauderdale          Anderson Regional Medical Center                          Meridian                   1,695
    Lauderdale          Riley Hospital                                            Meridian                     759
    Lauderdale          Rush Foundation Hospital                                  Meridian                     554
                                     General Hospital Service Area 7                                           -
    NONE                NONE                                                      NONE                         -
                                     General Hospital Service Area 8                                         2,946
    Forrest             Forrest General Hospital                                  Hattiesburg                1,266
    Jones               South Central Regional Medical Center                     Laurel                     1,451
    Lamar               Wesley Medical Center                                     Hattiesburg                  229
                                     General Hospital Service Area 9                                         2,047
    Harrison            Garden Park Medical Center                                Gulfport                     817
    Harrison            Memorial Hospital at Gulfport                             Gulfport                     386
    Jackson             Ocean Springs Hospital                                    Ocean Springs                430
    Jackson             Singing River Hospital                                    Pascagoula                   414
    State Total                                                                                             53,779

    1
        Indicates freestanding clinics.


    Sources: Applications for Renewal of Hospital License for Calendar Years 2010; Fiscal Year 2009 Annual Hospital
    Report; FY 2009 DSA Utilization Survey.




Chapter 5 – Acute Care                                     46                                2011 State Health Plan
112 Positron Emission Tomography (PET)

      Positron emission tomography (PET) is a minimally invasive imaging procedure in which
      positron-emitting radionuclides, produced either by a cyclotron or by a radio-pharmaceutical
      producing generator, and a gamma camera are used to create pictures of organ function rather
      than structure. PET scans provide physicians a crucial assessment of the ability of specific
      tissues to function normally.

      PET can provide unique clinical information in an economically viable manner, resulting in a
      diagnostic accuracy that affects patient management. PET scans provide diagnostic and
      prognostic patient information regarding cognitive disorders; for example, identifying the
      differences between Alzheimer's, Parkinson's, dementia, depression, cerebral disorders, and
      mild memory loss. PET scans also provide information regarding psychiatric disease, brain
      tumors, epilepsy, cardiovascular disease, movement disorders, and ataxia. Research shows that
      clinical PET may obviate the need for other imaging procedures.

      PET installations generally take one of two forms: a scanner using only generator-produced
      tracers (basic PET unit) or a scanner with a cyclotron (enhanced PET unit). The rubidium-82 is
      the only generator approved by the FDA to produce radiopharmaceuticals. Rubidium limits
      PET services to cardiac perfusion imaging.

      A PET scanner supported by a cyclotron can provide the capabilities for imaging a broader
      range of PET services, such as oncology, neurology, and cardiology. Manufacturers of PET
      equipment are providing more user-friendly cyclotrons, radiopharmaceutical delivery systems,
      and scanners which have drastically reduced personnel and maintenance requirements. These
      changes have made the cost of PET studies comparable to those of other high-technology
      studies.

      Table 5-9 presents the location, type (fixed or mobile), and utilization of PET equipment
      throughout the state in 2009.




2011 State Health Plan                            47                           Chapter 5 – Acute Care
                                                 Table 5-9
                           Location and Number of PET Procedures by Service Area
                                                 FY 2009

                                                                                      Type of          Number of PET
                            Facility                               Location
                                                                                     Equipment          Procedures
                                  General Hospital Service Area 1                                              283
    Baptist Memorial Hospital - DeSoto                   Southhaven                       M                      283
                                 General Hospital Service Area 2                                               2,745
    Magnolia Regional Health Center                      Corinth                          M                      475
    North Mississippi Medical Center                     Tupelo                           F                    2,270
    TIC at Gloster Creek Village                         Tupelo                           M                         0
                                 General Hospital Service Area 3                                                 553
    Bethesda Regional Cancer Treatment Center1           Clarksdale                       M                       26
    Bolivar Medical Center                               Cleveland                        M                      250
    Delta Regional Medical Center (Main Campus)          Greenville                       M                       70
    Greenwood Leflore Hospital                            Greenwood                       M                      207
                                  General Hospital Service Area 4                                              1,403
    Baptist Memorial Hospital - Golden Triangle                Columbus                   F                      666
    Baptist Memorial Hospital - North Miss               Oxford                           F                      431
    Grenada Diagnostics Radiology, LLC                   Grenada                          M                      306
                                 General Hospital Service Area 5                                               5,010
    Central Miss Medical Center                          Jackson                          F                      703
    Mississippi Baptist Medical Center                   Jackson                          F                    2,362
    St. Dominic Hospital                                 Jackson                          F                      726
    University Hospital & Health System                        Jackson                    F                    1,219
                                  General Hospital Service Area 6                                                396
    Anderson Regional Medical Center                   Meridian                           M                      396
                               General Hospital Service Area 7                                                   249
    Natchez Regional Medical Center                    Natchez                            M                      239
    Southwest MS Regional Medical Center               McComb                             M                       10
                               General Hospital Service Area 8                                                 1,757
    Hattiesburg Clinic, P.A.                            Hattiesburg                       F                    1,179
    South Central Regional Medical Center               Laurel                            F                      342
    Wesley Medical Center                               Hattiesburg                       M                      236
                                General Hospital Service Area 9                                                1,820
    Biloxi Regional Medical Center                      Biloxi                            M                      170
    Garden Park Medical Center                          Gulfport                          M                      100
    Memorial Hospital at Gulfport                       Gulfport                          M                      841
    Ocean Springs Hospital                              Ocean Springs                     M                      232
    Singing River Hospital                              Pascagoula                        M                      477
    State Total                                                                                               14,216

    1
     Indicates freestanding clinics.
    NOTE: Delta Cancer Institute CON approved but CON was amended. Delta RMC(Main Campus) provides service.
    Sources: Applications for Renewal of Hospital License for Calendar Years 2010; Fiscal Year 2009 Annual Hospital
    Report; FY 2009 PET Utilization Survey



Chapter 5 – Acute Care                                    48                                  2011 State Health Plan
 112.01    Certificate of Need Criteria and Standards for Magnetic Resonance Imaging Services
           (MRI)

     Note: Should the Mississippi State Department of Health receive a Certificate of Need
     application regarding the acquisition and/or otherwise control of major medical equipment or the
     provision of a service for which specific CON criteria and standards have not been adopted, the
     application shall be deferred until the Department of Health has developed and adopted CON
     criteria and standards. If the Department has not developed CON criteria and standards within
     180 days of receiving a CON application, the application will be reviewed using the general CON
     review criteria and standards presented in the Mississippi Certificate of Need Review Manual and
     all adopted rules, procedures, and plans of the Mississippi State Department of Health.


     112.01.01    Policy Statement Regarding Certificate of Need Applications for the Acquisition or
                  Otherwise Control of Magnetic Resonance Imaging (MRI) Equipment and/or the
                  Offering of MRI Services

1.   CON Review Requirements: The Certificate of Need process regarding the acquisition or
     otherwise control of MRI equipment and/or the offering of MRI services involves separate
     requirements for CON review: (a) an entity proposing to acquire or otherwise control MRI
     equipment must obtain a CON to do so if the capital expenditure for the MRI unit and related
     equipment exceeds $1,500,000; and (b) an entity proposing to offer MRI services must obtain a
     CON before providing such services.

2.   CON Approval Preference: The Mississippi State Department of Health shall give preference to
     those applicants proposing to enter into joint ventures utilizing mobile and/or shared equipment.
     However, the applicant must meet the applicable CON criteria and standards provided herein and
     the general criteria and standards contained in the currently approved Mississippi Certificate of
     Need Review Manual.

3.   For purposes of this Plan, a mobile MRI unit is defined as an MRI unit operating at two or more
     host sites and that has a central service coordinator. The mobile MRI unit shall operate under a
     contractual agreement for the provision of MRI services at each host site on a regularly scheduled
     basis.

4.   The conversion from mobile MRI service to fixed MRI service is considered the establishment of
     a new MRI service and requires CON review.

5.   Utilization of Existing Units: No new MRI services shall be approved unless all existing MRI
     service in the applicant’s defined service area performed an average of 1,700 MRI procedures per
     existing and approved MRI scanner during the most recent 12 month reporting period and the
     proposed new services would not reduce the utilization of existing providers in the service area.

6.   Population-Based Formula: The MSDH shall use a population-based formula as presented at the
     end of this chapter when calculating MRI need. Also, the formula will use historical and projected
     use rates by service area and patient origin data. The population-based formula is based on the
     most recent population projections prepared by the Center for Policy Research and Planning of the
     Institutions of Higher Learning. The applicant shall project a reasonable population base to justify
     the provision of 2,700 procedures by the second year of operation.




 2011 State Health Plan                              49                           Chapter 5 – Acute Care
7.      The required minimum service volumes for the establishment of services and the addition of
        capacity for mobile services shall be prorated on a ―site by site‖ basis based on the amount of time
        the mobile services will be operational at each site.

8.      Addition of a Health Care Facility: An equipment vendor who proposes to add a health care
        facility to an existing or proposed route must notify the Department in writing of any proposed
        changes, i.e., additional health care facilities or route deviations, from those presented in the
        Certificate of Need application prior to such change.


         112.01.02    Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                      Control of Magnetic Resonance Imaging (MRI) Equipment and/or the Offering of
                      MRI Services

               The Mississippi State Department of Health will review applications for a Certificate of
               Need for the acquisition or otherwise control of MRI equipment and/or the offering of MRI
               services under the applicable statutory requirements of Sections 41-7-173, 41-7-191, and
               41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review applications
               for Certificate of Need according to the general criteria listed in the Mississippi Certificate
               of Need Review Manual; all adopted rules, procedures, and plans of the Mississippi State
               Department of Health; and the specific criteria and standards listed below.

               The acquisition or otherwise control of MRI equipment is reviewable if the equipment cost
               is in excess of $1,500,000; if the equipment and/or service is relocated; and if the proposed
               provider of MRI services has not provided such services on a regular basis within the period
               of twelve (12) months prior to the time such services would be offered.


         112.01.03 Certificate of Need Criteria and Standards for the Acquisition or Otherwise
                      Control of MRI Equipment

                  1. Need Criterion: The entity desiring to acquire or otherwise control the MRI
                     equipment shall demonstrate a minimum of 2,700 procedures per year by the
                     end of the second year of operation. This criterion includes both fixed and
                     mobile MRI equipment. The applicant must show the methodology used for the
                     projections.

                      a. Applicants for non-hospital based MRI facilities may submit affidavits from
                         referring physicians. MRI procedures projected in affidavits shall be based
                         on actual MRI procedures referred during the year.

                      b. The applicant shall document a reasonable population base to document that
                         a minimum of 2,700 procedures will be performed per proposed MRI unit.

                      c. The applicant shall demonstrate that all existing units within its defined
                         service area have performed an average of 1,700 procedures for the most
                         recent 12-month period.

                     It is recognized that an applicant desiring to acquire or otherwise control an MRI unit
                     may make or propose to make the MRI unit available to more than one provider of
                     MRI services, some of which may be located outside of Mississippi. In such cases all



     Chapter 5 – Acute Care                              50                             2011 State Health Plan
                 existing or proposed users of the MRI unit must jointly meet the required service
                 volume of 2,700 procedures annually. If the MRI unit in question is presently utilized
                 by other providers of MRI services, the actual number of procedures performed by
                 them during the most recent 12-month period may be used.

             2. In order to receive CON approval to acquire or otherwise control MRI equipment, the
                applicant shall provide a copy of the proposed contract and document the following:

                  a. that the equipment is FDA approved;

                  b. that only qualified personnel will be allowed to operate the equipment; and

                  c. that if the equipment is to be rented, leased, or otherwise used by other qualified
                     providers on a contractual basis, no fixed/minimum volume contracts will be
                     permitted.

             3. Applicants shall provide written assurance that they will record and maintain, at a
                minimum, the following information and make it available to the Mississippi State
                Department of Health:

                  a. all facilities which have access to the equipment;

                  b. utilization by each facility served by the equipment, e.g., days of operation,
                     number of procedures, and number of repeat procedures;

                  c. financial data, e.g., copy of contracts, fee schedule, and cost per scan; and

                  d. demographic and patient origin data for each facility.

                 In addition, if required by the Department, the above referenced information and
                 other data pertaining to the use of MRI equipment will be made available to the
                 MSDH within 15 business days of request. The required information may also be
                 requested for entities outside of Mississippi that use the MRI equipment in question.

             4. The entity desiring to acquire or otherwise control the MRI equipment must be a
                registered entity authorized to do business in Mississippi.

             5. Before the specified equipment can be utilized, the applicant desiring to provide the
                MRI equipment shall have CON approval or written evidence that the equipment is
                exempt from CON approval, as determined by the Mississippi State Department of
                Health. Each specified piece of equipment must be exempt from or have CON
                approval.


      112.01.04     Certificate of Need Criteria and Standards for the Offering of Fixed or Mobile
                    MRI Services

          An entity proposing to offer MRI services shall obtain Certificate of Need (CON) approval
          before offering such services.

            1. Need Criterion: The entity desiring to offer MRI services must document that
               the equipment shall perform a minimum of 2,700 procedures by the end of the


2011 State Health Plan                               51                            Chapter 5 – Acute Care
                second year of operation. This criterion includes both fixed and mobile MRI
                equipment. The applicant must show methodology used for the projections.

                 a. Applicants for non-hospital based MRI facilities may submit affidavits from
                   referring physicians. MRI procedures projected in affidavits shall be based
                   on actual MRI procedures referred during the year.

                 b. The applicant shall document a reasonable population within its service area
                    to justify 2,700 procedures per proposed MRI unit.

                 c. The applicant shall demonstrate that all existing units within its defined
                    service area have performed an average of 1,700 procedures for the most
                    recent 12-month period.

                It is recognized that a particular MRI unit may be utilized by more than one provider
                of MRI services, some of which may be located outside of Mississippi. In such cases
                all existing or proposed providers of MRI services must jointly meet the required
                service volume of 2,700 procedures annually by the end of the second year of
                operation. If the MRI unit in question is presently utilized by other providers of MRI
                services, the actual number of procedures performed by them during the most recent
                12-month period may be used instead of the formula projections.

             2. An applicant desiring to offer MRI services must document that a full range of
                diagnostic imaging modalities for verification and complementary studies will be
                available at the time MRI services begin. These modalities shall include, but not be
                limited to, computed tomography (full body), ultrasound, angiography, nuclear
                medicine, and conventional radiology.

             3. All applicants proposing to offer MRI services shall give written assurance that,
                within the scope of its available services, neither the facility where the service is
                provided nor its participating medical personnel shall have policies or procedures
                which would exclude patients because of race, color, age, sex, ethnicity, or ability to
                pay.

             4. The applicant must document that the following staff will be available:

                 a. Director - A full-time, board eligible radiologist or nuclear medicine imaging
                    physician, or other board eligible licensed physician whose primary responsibility
                    during the prior three years has been in the acquisition and interpretation of
                    clinical images. The Director shall have knowledge of MRI through training,
                    experience, or documented post-graduate education. The Director shall document
                    a minimum of one week of full-time training with a functional MRI facility.

                 b. One full-time MRI technologist-radiographer or a person who has had equivalent
                    education, training, and experience, who shall be on-site at all times during
                    operating hours. This individual must be experienced in computed tomography or
                    other cross-sectional imaging methods, or must have equivalent training in MRI
                    spectroscopy.

             5. The applicant shall document that when an MRI unit is to be used for experimental
                procedures with formal/approved protocols, a full-time medical physicist or MRI



Chapter 5 – Acute Care                              52                            2011 State Health Plan
                scientist (see definition in Glossary) with at least one year of experience in diagnostic
                imaging shall be available in the facility.

             6. The applicant shall provide assurances that the following data regarding its use of the
                MRI equipment will be kept and made available to the Mississippi State Department
                of Health upon request:

                 a. Total number of procedures performed

                 b. Number of inpatient procedures

                 c. Number of outpatient procedures

                 d. Average MRI scanning time per procedure

                 e. Average cost per procedure

                 f. Average charge per procedure

                 g. Demographic/patient origin data

                 h. Days of operation

                 In addition to the above data recording requirements, the facility should maintain the
                 source of payment for procedures and the total amounts charged during the fiscal
                 year when it is within the scope of the recording system.

             7. Before the service can be provided, the CON applicant desiring to offer MRI services
                shall provide written evidence that the specified MRI equipment provider has
                received CON approval or is exempt from CON approval as determined by the
                Mississippi State Department of Health. Each specified piece of equipment must be
                exempt from or have CON approval.




2011 State Health Plan                              53                            Chapter 5 – Acute Care
112.01.05        Population-Based Formula for Projection of MRI Service Volume


                  X * Y ÷1,000 = V


                  Where, X = Applicant’s Defined Service area population


                          Y = Mississippi MRI Use Rate*


                          V = Expected Volume


                  *Use Rate shall be based on information in the State Health Plan


  113        Certificate of Need Criteria and Standards for Diagnostic Imaging Services

        Note: Should the Mississippi State Department of Health receive a Certificate of Need
        application regarding the acquisition and/or otherwise control of major medical equipment or
        the provision of a service for which specific CON criteria and standards have not been adopted,
        the application shall be deferred until the Department of Health has developed and adopted
        CON criteria and standards. If the Department has not developed CON criteria and standards
        within 180 days of receiving a CON application, the application will be reviewed using the
        general CON review criteria and standards presented in the Mississippi Certificate of Need
        Review Manual and all adopted rules, procedures, and plans of the Mississippi State
        Department of Health.


        113.01    Certificate of Need Criteria and Standards for Digital Subtraction Angiography

        The Mississippi State Department of Health will review applications for a Certificate of Need
        for the acquisition or otherwise control of Digital Subtraction Angiography (DSA) equipment
        and associated costs under the applicable statutory requirements of Sections 41-7-173,
        41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review
        applications for Certificate of Need according to the general criteria listed in the Mississippi
        Certificate of Need Review Manual; all adopted rules, procedures, and plans of the Mississippi
        State Department of Health; and the specific criteria and standards listed below.

        Certificate of Need review is required when the capital expenditure for the purchase of Digital
        Subtraction Angiography equipment and associated costs exceed $1,500,000, or when the
        equipment is to be used for invasive procedures, i.e., the use of catheters. The offering of
        diagnostic imaging services of an invasive nature, i.e. invasive digital angiography, is
        reviewable if those services have not been provided on a regular basis by the proposed provider
        of such services within the period of twelve (12) months prior to the time such services would
        be offered.

        1.   Need Criterion: The applicant for DSA services shall demonstrate that proper
             protocols for screening, consultation, and medical specialty backup are in place
             before services are rendered by personnel other than those with specialized training.


Chapter 5 – Acute Care                               54                            2011 State Health Plan
    For example, if a radiologist without specialized training in handling cardiac arrhythmia is to
    perform a procedure involving the heart, a cardiologist/cardiosurgeon must be available for
    consultation/backup.

    The protocols shall include, but are not limited to, having prior arrangements for
    consultation/backup from:

       a. a cardiologist/cardiosurgeon for procedures involving the heart;

       b. a neurologist/neurosurgeon for procedures involving the brain; and

       c. a vascular surgeon for interventional peripheral vascular procedures.

  2.     Before utilizing or providing the equipment or service, the applicant desiring to provide the
         digital subtraction angiography equipment or service shall have CON approval or written
         evidence that the equipment or service is exempt from CON approval as determined by the
         Mississippi State Department of Health.


113.02    Positron Emission Tomography (PET) Equipment and Services


  113.02.01 Policy Statement Regarding Certificate of Need Applications for the Acquisition or
               Otherwise Control of a Positron Emission Tomography (PET) Scanner and Related
               Equipment including Cardiac only PET Scanner

             1. CON Review Requirements: Applicants proposing the acquisition or otherwise
                control of a PET scanner shall obtain a CON to do so if the capital expenditure for the
                scanner and related equipment exceeds $1,500,000.

             2. Indigent/Charity Care: An applicant shall be required to provide a "reasonable
                amount" of indigent/charity care as described in Chapter I of this Plan.

             3. Service Areas: The state as a whole shall serve as a single service area in determining
                the need for a PET scanner. In the case of Cardiac only PET Scanner, the service
                area will be the General Hospital Service Areas.

             4. Equipment to Population Ratio: The need for a PET scanner is estimated to be one
                scanner per 300,000 population. The MSDH will consider out-of-state population in
                determining need only when the applicant submits adequate documentation
                acceptable to the MSDH, such as valid patient origin studies. In the case of Cardiac
                only PET Scanner, this policy will not apply.

             5. Access to Supplies: Applicants must have direct access to appropriate radio-
                pharmaceuticals.

             6. Services and Medical Specialties Required: The proposed PET unit must function as
                a component of a comprehensive inpatient or outpatient diagnostic service. The
                proposed PET unit must have the following modalities (and capabilities) on-site or
                through contractual arrangements:

                 a.      Computed tomography - (whole body)


2011 State Health Plan                              55                            Chapter 5 – Acute Care
                b.        Magnetic resonance imaging - (brain and whole body)
                     c.      Nuclear medicine - (cardiac, SPECT)
                     d.      Conventional radiography
                     e.      The following medical specialties during operational hours:
                               i. Cardiology
                               ii. Neurology
                               iii. Neurosurgery
                               iv. Oncology
                               v. Psychiatry
                               vi. Radiology
             7. Hours of Operation: PET facilities should have adequate scheduled hours to avoid an
                excessive backlog of cases.

             8. CON Approval Preference: The MSDH may approve applicants proposing to enter
                joint ventures utilizing mobile and/or shared equipment.

             9. CON Requirements: The criteria and standards contained herein pertain to both fixed
                and/or mobile PET scanner equipment.

             10. CON Exemption: Nothing contained in these CON criteria and standards shall
                 preclude the University of Mississippi School of Medicine from acquiring and
                 operating a PET scanner and a Cardiac only PET Scanner, provided the acquisition
                 and use of such equipment is justified by the School's teaching and/or research
                 mission. However, the requirements listed under the section regarding the granting
                 of "appropriate scope of privileges for access to the scanner to any qualified
                 physician" must be met. The MSDH shall not consider utilization of
                 equipment/services at any hospital owned and operated by the state or its agencies
                 when reviewing CON applications.

             11. Addition to a Health Care Facility: An equipment vendor who proposes to add a
                 health care facility to an existing or proposed route must notify the Department in
                 writing of any proposed changes from those presented in the Certificate of Need
                 application prior to such change, i.e., additional health care facilities or route
                 deviations.

             12. Equipment Registration: The applicant must provide the Department with the
                 registration/serial number of the CON-approved PET scanner.

             13. Certification: If a mobile PET scanner, the applicant must certify that only the
                 single authorized piece of equipment and related equipment vendor described in the
                 CON application will be utilized for the PET service by the authorized
                 facility/facilities.

             14. Conversion from mobile to fixed service: The conversion from mobile PET service
                 site to a fixed PET service site is considered the establishment of a new service and
                 requires CON review.



Chapter 5 – Acute Care                              56                           2011 State Health Plan
  113.02.02 Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control
                of a Positron Emission Tomography (PET) Scanner and Related Equipment
                including Cardiac only PET Scanner

          The Mississippi State Department of Health will review applications for a Certificate of
          Need for the acquisition or otherwise control of a PET scanner and related equipment under
          the applicable statutory requirements of Sections 41-7-173, 41-7-191, and 41-7-193,
          Mississippi Code of 1972, as amended. The MSDH will also review applications for
          Certificate of Need according to the general review criteria listed in the Mississippi
          Certificate of Need Review Manual; all adopted rules, procedures, and plans of the
          Mississippi State Department of Health; and the specific criteria and standards listed below.

          The acquisition or otherwise control of a PET scanner and related equipment is reviewable
          if the equipment cost is in excess of $1,500,000, or if the equipment is relocated. The
          offering of PET services is reviewable if the proposed provider has not provided those
          services on a regular basis within the period of twelve (12) months prior to the time such
          services would be offered.

           1.    Need Criterion:

                    a. The entity desiring to acquire or to otherwise control the PET scanner
                       must project a minimum of 1,000 clinical procedures per year and must
                       show the methodology used for the projection.

                    b. The applicant shall document a minimum population of 300,000 per PET
                       scanner unit. The Division of Health Planning and Resource Development
                       population projections shall be used. In the case of Cardiac only PET
                       Scanner, this Criterion will not apply.

           2. The entity desiring to acquire or otherwise control the PET equipment must be a
              registered entity authorized to do business in Mississippi.

           3. The MSDH will approve additional PET equipment in a service area with existing
              equipment only when it is demonstrated that the existing PET equipment in that
              service area is performing an average of 1,500 clinical procedures per PET unit per
              year (six clinical procedures per day x 250 working days per year). For purposes of
              this Criterion, PET and Cardiac only PET are to be evaluated separately.

           4. The application shall affirm that the applicant shall receive approval from the Division
              of Radiological Health for the proposed site, plans, and equipment before service
              begins.

           5. The applicant shall provide assurances that the following data regarding the PET
              equipment will be kept and made available to the Mississippi State Department of
              Health upon request:

                    a.   total number of procedures performed;

                    b.   total number of inpatient procedures (indicate type of procedure);




2011 State Health Plan                             57                            Chapter 5 – Acute Care
                       c.      total number of outpatient procedures (indicate type of procedure);

                       d.      average charge per specific procedure;

                              e.   hours of operation of the PET unit;

                              f.   days of operation per year; and

                              g. total revenue and expense for the PET unit for the year.

                 6. The applicant shall provide a copy of the proposed contract and document that if the
                    equipment is to be rented, leased, or otherwise used by other qualified providers on a
                    contractual basis, no fixed/minimum volume contracts will be permitted.

                 7. Before the specified equipment can be utilized, the applicant desiring to provide the
                    PET equipment shall have CON approval or written evidence that the equipment is
                    exempt from CON approval as determined by the Mississippi State Department of
                    Health. Each specified piece of equipment must be exempt from or have CON
                    approval.


113.02.03         Certificate of Need Criteria and Standards for the Offering of Fixed or Mobile
                  Positron Emission Tomography (PET) Services including Cardiac only PET
                  Scanner

    The offering of fixed or mobile PET services is reviewable if the proposed provider has not
    provided those services on a regular basis within the period of twelve (12) months prior to the
    time such services would be offered.

    1.      Need Criterion: The entity desiring to offer PET services must document that the
            equipment shall perform a minimum of 1,000 clinical procedures per year and must show
            the methodology used for the projection.

    2.      It is recognized that a particular PET unit may be utilized by more than one provider of
            PET services, some of which may be located outside of Mississippi. In such cases all
            existing or proposed providers of PET services utilizing the same PET unit must jointly
            meet the required service volume of 1,000 procedures annually. If the PET unit in question
            is presently utilized by other providers of PET services, the actual number of procedures
            performed by them during the most recent 12-month period may be used.

    3.      An applicant proposing to provide new or expanded PET services must include written
            assurances in the application that the service will be offered in a physical environment that
            conforms to federal standards, manufacturer's specifications, and licensing agencies'
            requirements. The following areas are to be addressed:

            a.              quality control and assurance of radiopharmaceutical production of generator or
                            cyclotron-produced agents;

            b.              quality control and assurance of PET tomograph and associated instrumentation;

            c.              radiation protection and shielding; and



Chapter 5 – Acute Care                                    58                           2011 State Health Plan
                 d.        radioactive emissions to the environment.

       4.        The application shall affirm that the applicant shall receive approval from the Division of
                 Radiological Health for the proposed site, plans, and equipment before service begins.

5.       The applicant shall document provision of an on-site medical cyclotron for radionuclide
         production and a chemistry unit for labeling radiopharmaceuticals; or an on-site rubidium-82
         generator; or access to a supply of cyclotron-produced radiopharmaceuticals from an off-site
         medical cyclotron and a radiopharmaceutical production facility within a two-hour air transport
         radius.

6.       Applicants for PET shall document that the necessary qualified staff are available to operate the
         proposed unit. The applicant shall document the PET training and experience of the staff. The
         following minimum staff shall be available to the PET unit:

            a.     If operating a fixed PET unit, one or more nuclear medicine imaging physician(s)
                   available to the PET unit on a full-time basis (e.g., radiologist, nuclear cardiologist) who
                   have been licensed by the state for the handling of medical radionuclides and whose
                   primary responsibility for at least a one-year period prior to submission of the Certificate
                   of Need application has been in acquisition and interpretation of tomographic images.
                   This individual shall have knowledge of PET through training, experience, or
                   documented postgraduate education. The individual shall also have training with a
                   functional PET facility.

            b. If operating a cyclotron on site, a qualified PET radiochemist or radiopharmacist
               personnel, available to the facility during PET service hours, with at least one year of
               training and experience in the synthesis of short-lived positron emitting
               radiopharmaceuticals. The individual(s) shall have experience in the testing of chemical,
               radiochemical, and radionuclidic purity of PET radiopharmaceutical syntheses.

            c.     Qualified engineering and physics personnel, available to the facility during PET service
                   hours, with training and experience in the operation and maintenance of the PET
                   equipment. Engineering personnel are not required on-site for mobile PET units.

            d. Qualified radiation safety personnel, available to the facility at all times, with training
               and experience in the handling of short-lived positron emitting nuclides. If a medical
               cyclotron is operated on-site, personnel with expertise in radiopharmacy, radiochemistry,
               and medical physics would also be required.

            e.     Certified nuclear medicine technologists with expertise in computed tomographic nuclear
                   medicine imaging procedures, at a staff level consistent with the proposed center's
                   expected PET service volume.

            f.     Other appropriate personnel shall be available during PET service hours which may
                   include certified nuclear medicine technologists, computer programmers, nurses, and
                   radio-chemistry technicians.

     7. The applicant shall demonstrate how medical emergencies within the PET unit will be managed
        in conformity with accepted medical practice.




2011 State Health Plan                                    59                            Chapter 5 – Acute Care
  8. The applicant shall affirm that, in addition to accepting patients from participating institutions,
     facilities performing clinical PET procedures shall accept appropriate referrals from other local
     providers. These patients shall be accommodated to the extent possible by extending the hours
     of service and by prioritizing patients according to standards of need and appropriateness rather
     than source of referral.

      9. The applicant shall affirm that protocols will be established to assure that all clinical PET
         procedures performed are medically necessary and cannot be performed as well by other,
         less expensive, established modalities.

     10. Applicants will be required to maintain current listings of appropriate PET procedures for
         use by referring physicians.

     11. The applicant shall provide assurances that the following data regarding the PET service
         will be kept and made available to the Mississippi State Department of Health upon
         request:

             a.      total number of procedures performed; total number of inpatient procedures
                     (indicate type of procedure);

             b.      total number of outpatient procedures (indicate type of procedure);

             c.      average charge per specific procedure;

             d.      hours of operation of the PET unit;

             e.      days of operation per year; and

             f.      total revenue and expense for the PET unit for the year.

     12. Before the specified service can be provided, the applicant desiring to offer the PET
         service shall provide written evidence that the specified PET equipment provider has CON
         approval or written evidence that the equipment is exempt from CON approval as
         determined by the Mississippi State Department of Health. Each specified piece of
         equipment must be exempt from or have CON approval.




Chapter 5 – Acute Care                              60                            2011 State Health Plan
OPEN-HEART SURGERY SERVICES
114 Cardiac Catheterization

   Cardiac catheterization, predominately a diagnostic tool that is an integral part of cardiac
   evaluation, brings together two disciplines: cardiac catheterization (the evaluation of cardiac
   function) and angiography (X-ray demonstration of cardiac anatomy). Cardiac catheterization
   includes various therapeutic interventions: dilation of coronary obstructions by percutaneous
   transluminal coronary angioplasty (PTCA), acute lysis of coronary clots in evolving myocardial
   infarctions by injection of intracoronary streptokinase, electrical ablation of abnormal conduction
   pathways, and closure of patent ductus arteriosus in infants.

   Any facility performing diagnostic cardiac catheterizations without open-heart surgery capability
   must maintain formal referral agreements with a nearby facility to provide emergency cardiac
   services, including open-heart surgery. Such a facility must also delineate the steps it will take to
   ensure that high-risk or unstable patients are not catheterized in the facility. Additionally, a facility
   without open-heart surgery capability must document that more complex procedures are not
   performed in the facility. Such procedures include, but are not limited to: PTCA, transseptal
   puncture, transthoracic left ventricular puncture, and myocardial biopsy.

   Note: Percutaneous Transluminal Coronary Angioplasty (PTCA) is an angiographic
   technique to improve myocardial blood flow by dilating focal atherosclerotic stenoses in coronary
   arteries. The technique consists of mechanically induced coronary vasodilation and recanalization.
   It is expected to result in the restoration of blood flow through segmentally diseased coronary
   arteries. PTCA involves the passage of a balloon-tipped flexible catheter into a site of arterial
   narrowing. The balloon is inflated in situ to dilate and recanalize the obstructed vessel. Specially
   trained physicians perform the procedure on hospitalized patients with symptomatic coronary
   artery disease (CAD) who meet the required patient selection criteria.

   Section 41-7-191(1)(d), Mississippi Code of 1972, as amended, requires Certificate of Need
   review for the establishment and/or offering of cardiac catheterization services if the proposed
   provider has not offered such services on a regular basis within 12 months prior to the time the
   services would be offered. Table 5-10 presents the utilization of cardiac catheterization services in
   2009.




2011 Sate Health Plan                                 63                            Chapter 5 – Acute Care
                                               Table 5-10
                             Cardiac Catheterizations by Facility and Type
                    by Cardiac Catherization/Open Heart Planning Area (CC/OHSPA)
                                          FY 2008 and FY 2009


                                                             Total Adult     Total Pediatric     Total PTCA
                    Facility                     County
                                                              Procedures       Procedures         Procedures      # Labs
                                                             2008    2009     2008 2009         2008       2009    2009
                CC/OHSPA 1                                  3,983     2,367      0         0       689      835         3
  Baptist Memorial Hospital-DeSoto            DeSoto        3,983     2,367      0         0       689      835         3
                 CC/OHSPA 2                                 9,210     9,394      0         0       579      591         6
  Magnolia Regional Health Center             Alcorn        1,545     1,529      0         0       417      475         2
  North Mississippi Medical Center            Lee           7,665     7,865      0         0       162      116         4
                 CC/OHSPA 3                                 1,401     1,304      0         0       166       85         3
  Delta Regional Medical Center               Washington      899        703     0         0       166       85         2
  NW Mississippi Regional Med Center*         Coahoma         502        601     0         0         0        0         1
                CC/OHSPA 4                                  3,324     3,342      0         0       320      439         4
  Baptist Memorial Hospital-Golden Triangle   Lowndes       1,866     2,022      0         0        23        0         1
  Baptist Memorial Hospital-N. Mississippi    Lafayette     1,265     1,096      0         0       297      439         2
  Grenada Lake Medical Center*                Grenada         193        224     0         0         0        0         1
                  CC/OHSPA 5                               12,872    14,938    591      884      3,169    2,685       21
  Central Mississippi Medical Center          Hinds           500        571     0         0       150      205         3
  Mississippi Baptist Medical Center          Hinds         4,135     3,445      0         0     1,263      978         4
  Rankin Cardiology Center*•                  Rankin          102         40     0         0         0        0         1
  River Region Health System                  Warren        2,415     1,500      0         0       576      420         3
  St. Dominic-Jackson Memorial Hospital       Hinds         2,288     2,688      0         0       850    1,052         5
  University Hospital & Health Systems        Hinds         3,432     6,694    591      884        330       30         5
                 CC/OHSPA 6                                 1,241     2,818      1         0       190      963         5
  Anderson Medical Center                     Lauderdale         -    1,087      0         0         0      529         3
  Riley Hospital* 1                           Lauderdale       84         77     0         0         7        0         0
  Rush Foundation Hospital                    Lauderdale    1,157     1,654      1         0       183      434         2
                 CC/OHSPA 7                                 1,176     1,280      0         0       400        0         3
  Natchez Regional Medical Center *           Adams              -         0     0         0         0        0         0
  SW Miss Regional Medical Center             Pike          1,176     1,280      0         0       400        0         3
                 CC/OHSPA 8                                 3,872     4,600      0        10     1,332    1,617         7
  Forrest General Hospital                    Forrest       2,097     2,488      0         0       906     1092         4
  South Central Regional Medical Center*      Jones           598        730     0         0         0        0         1
  Wesley Medical Center                       Lamar         1,177     1,382      0        10       426      525         2
                 CC/OHSPA 9                                 6,677     6,452      0         0     1,967    1,897         9
  Biloxi Regional Medical Center*             Harrison        185        130     0         0         0        0         1
  Memorial Hospital at Gulfport               Harrison      4,156     4,147      0         0       921      879         4
  Ocean Springs Hospital                      Jackson       1,195     1,182      0         0       508      546         2
  Singing River Hospital                      Jackson       1,141        993     0         0       538      472         2
  State Total                                              43,756    46,495    592      894      8,812    9,112       61

  *Diagnostic Catheterizations only
  •Provides Diagnostic Cardiac Catheterizations for Rankin Medical Center, Women’s Hospital, and River
  Oaks Hospital patients, at River Oaks Hospital Campus
  1
    Anderson Regional Medical Center provides Diagnostic Cardiac Catheterizations for Riley Memorial
  Hospital.

  Sources: Applications for Renewal of Hospital License for Calendar Years 2009 and 2010, and Fiscal Years
  2008 and 2009 Annual Hospital Reports.




Chapter 5 – Acute Care                                     64                                  2011 State Health Plan
115 Certificate of Need Criteria and Standards for Cardiac Catheterization Services
    and Open-Heart Surgery Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


  115.01 Joint Policy Statement Regarding Certificate of Need Applications for the Acquisition
         or Otherwise Control of Cardiac Catheterization Equipment and/or the Offering of
         Cardiac Catheterization Services and the Acquisition of Open-Heart Surgery
         Equipment and/or the Offering of Open-Heart Surgery Services

      Heart disease remains the leading cause of death in Mississippi as incidence rates continue to
      increase, particularly among the African-American population. Studies show that minorities
      have a higher cardiovascular death rate than whites and are less likely to receive cardiac
      catheterization and open-heart surgery services than are whites. The disproportionate impact on
      minorities' health status in general is recognized elsewhere in this State Health Plan.

      Innovative approaches to address these problems in the cardiac area are needed. It has been
      shown that statistical methods, such as population base and optimum capacity at existing
      providers, are not accurate indicators of the needs of the underserved, nor do they address the
      accessibility of existing programs to the underserved. The goal of these revisions to the State
      Health Plan is to improve access to cardiac care and to encourage the establishment of
      additional cardiac catheterization and open-heart surgery programs within the state that can
      serve the poor, minorities, and the rural population in greater numbers.

      To further this goal, the MSDH adopted the following standards:

      1.    A minimum population base standard of 100,000;

      2.    The establishment of diagnostic cardiac catheterization services with a caseload of 300
            diagnostic catheterization procedures;

      3.    The establishment of therapeutic cardiac catheterization services with a caseload of 450
            diagnostic and therapeutic catheterization procedures;

      4.    The establishment of open-heart surgery programs with a caseload of 150 open-heart
            surgeries; and,

      5.    A minimum utilization of equipment/services at existing providers of 450 cardiac
            catheterizations, diagnostic and therapeutic, and when applicable, 150 open-heart
            surgeries.




2011 State Health Plan                             65                           Chapter 5 – Acute Care
      The MSDH also adopted a provision that it shall not consider utilization of equipment/services
      at any hospital owned and/or operated by the state or its agencies when reviewing CON
      applications. The MSDH further adopted standards requiring an applicant to report information
      regarding catheterization and open-heart programs so as to monitor the provision of care to the
      medically underserved and the quality of that care.

      The MSDH shall interpret and implement all standards in this Plan in recognition of the stated
      findings and so as to achieve the stated goal.


115.02     Policy Statement Regarding Certificate of Need Applications for the Acquisition or
           Otherwise Control of Cardiac Catheterization Equipment and/or the Offering of
           Cardiac Catheterization Services

      1.    Cardiac Catheterization Services: For purposes of the following CON criteria and
            standards, the term "cardiac catheterization services" or "catheterization services" shall
            include diagnostic cardiac catheterization services and therapeutic cardiac catheterization
            services.

               a.   Diagnostic cardiac catheterization services are defined as, and refer to, cardiac
                    catheterization services which are performed for the purpose of diagnosing,
                    identifying, or evaluating cardiac related illness or disease. Diagnostic cardiac
                    catheterization services include, but are not limited to, left heart catheterizations,
                    right heart catheterizations, left ventricular angiography, coronary procedures, and
                    other cardiac catheterization services of a diagnostic nature. Diagnostic cardiac
                    catheterization services do not include percutaneous transluminal coronary
                    angioplasty (PTCA), transseptal puncture, transthoracic left ventricular puncture,
                    myocardial biopsy, and other cardiac catheterization procedures performed
                    specifically for therapeutic, as opposed to diagnostic, purposes.

               b. Therapeutic cardiac catheterization services are defined as, and refer to, cardiac
                  catheterization services which are performed for the purpose of actively treating,
                  as opposed to merely diagnosing, cardiac-related illness or disease. Therapeutic
                  cardiac catheterization services include, but are not limited to, PTCA, transseptal
                  puncture, transthoracic left ventricular puncture and myocardial biopsy.

      2.    Open-Heart Surgery Capability: The MSDH shall not approve CON applications for the
            establishment of therapeutic cardiac catheterization services at any facility that does not
            have open-heart surgery capability; i.e., new therapeutic cardiac catheterization services
            may not be established and existing therapeutic cardiac catheterization services may not
            be extended without approved and operational open-heart surgery services in place. This
            policy does not preclude approval of a Certificate of Need application proposing the
            concurrent establishment of both therapeutic cardiac catheterization and open-heart
            surgery services.

      3.    Service Areas: The need for cardiac catheterization equipment/services shall be
            determined using the nine designated Cardiac Catheterization/Open-Heart Surgery
            Planning Areas (CC/OHSPAs) presented in the Open Heart Surgery section of this chapter
            of the Plan. Map 5-2 shows the CC/OHSPAs.




Chapter 5 – Acute Care                               66                             2011 State Health Plan
      4.    CC/OHSPA Need Determination: The need for cardiac catheterization equipment/
            services within a given CC/OHSPA shall be determined independently of all other
            CC/OHSPAs.

      5.    Pediatric Cardiac Catheterization: Because the number of pediatric patients requiring
            study is relatively small, the provision of cardiac catheterization for neonates, infants, and
            young children shall be restricted to those facilities currently providing the service.
            National standards indicate that a minimum of 150 cardiac catheterization cases should be
            done per year and that catheterization of infants should not be performed in facilities
            which do not have active pediatric cardiac-surgical programs.

      6.    Present Utilization of Cardiac Catheterization Equipment/Services: The MSDH shall
            consider utilization of existing equipment/services and the presence of valid CONs for
            equipment/services within a given CC/OHSPA when reviewing CON applications. The
            MSDH shall not consider utilization of equipment/services at any hospital owned and/or
            operated by the state or its agencies when reviewing CON applications. The Mississippi
            State Department of Health may collect and consider any additional information it deems
            essential, including information regarding access to care, to render a decision regarding
            any application.

      7.    CON Application Analysis: At its discretion, the Department of Health may use market
            share analysis and other methodologies in the analysis of a CON application for the
            acquisition or otherwise control of cardiac catheterization equipment and/or the offering
            of cardiac catheterization services. The Department shall not rely upon market share
            analysis or other statistical evaluations if they are found inadequate to address access to
            care concerns.

      8.    Minimum CC/OHSPA Population: A minimum population base of 100,000 is required
            for applications proposing the establishment of cardiac catheterization services. The total
            population within a given CC/OHSPA shall be used when determining the need for
            services. Population outside an applicant's CC/OHSPA will be considered in determining
            need only when the applicant submits adequate documentation acceptable to the
            Mississippi State Department of Health, such as valid patient origin studies.

      9.    Minimum Caseload: Applicants proposing to offer adult diagnostic cardiac
            catheterization services must be able to project a caseload of at least 300 diagnostic
            catheterizations per year. Applicants proposing to offer adult therapeutic cardiac
            catheterization services must be able to project a caseload of at least 450 catheterizations,
            diagnostic and therapeutic, per year.

     10.    Residence of Medical Staff: Cardiac catheterizations must be under the control of and
            performed by personnel living and working within the specific hospital area. No site shall
            be approved for the provision of services by traveling teams.

     11.    Hospital-Based: All cardiac catheterizations and open-heart surgery services shall be
            located in acute care hospitals. The MSDH shall not approve Certificate of Need
            applications proposing the establishment of cardiac catheterization/open-heart surgery
            services in freestanding facilities or in freestanding ambulatory surgery facilities.




2011 State Health Plan                               67                            Chapter 5 – Acute Care
115.03     Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control
           of Diagnostic Cardiac Catheterization Equipment and/or the Offering of Diagnostic
           Cardiac Catheterization Services

      The Mississippi State Department of Health will review applications for a Certificate of Need
      for the acquisition or otherwise control of diagnostic cardiac catheterization equipment and/or
      the offering of diagnostic cardiac catheterization services under the applicable statutory
      requirements of Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as
      amended. The MSDH will also review applications for Certificate of Need according to the
      general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules,
      procedures and plans of the Mississippi State Department of Health; and the specific criteria
      and standards listed below.

      The acquisition or otherwise control of diagnostic cardiac catheterization equipment is
      reviewable if the equipment costs exceed $1,500,000. The offering of diagnostic cardiac
      catheterization services is reviewable if the proposed provider has not provided those services
      on a regular basis within the period of twelve (12) months prior to the time such services would
      be offered.

      1.    Need Criterion: The applicant shall document a minimum population base of 100,000 in
            the CC/OHSPA where the proposed diagnostic cardiac catheterization equipment/service
            is to be located. Division of Health Planning and Resource Development population
            projections shall be used.

      2.    Minimum Procedures: An applicant proposing the establishment of diagnostic cardiac
            catheterization services only shall demonstrate that the proposed equipment/service
            utilization will be a minimum of 300 diagnostic cardiac catheterizations per year by its
            third year of operation.

      3.    Impact on Existing Providers: An applicant proposing to acquire or otherwise control
            diagnostic cardiac catheterization equipment and/or offer diagnostic cardiac
            catheterization services shall document that each existing unit, which is (a) in the
            CC/OHSPA and (b) within forty-five (45) miles of the applicant, has been utilized for a
            minimum of 450 procedures (both diagnostic and therapeutic) per year for the two most
            recent years as reflected in data supplied to and/or verified by the Mississippi State
            Department of Health. No hospital owned and/or operated by the state or its agencies shall
            be considered an existing unit in the CC/OHSPA under this section. The Mississippi State
            Department of Health may collect and consider any additional information it deems
            essential, including information regarding access to care, to render a decision regarding
            any application.

      4.    Staffing Standards: The applicant shall document that it has, or can obtain, the ability to
            administer the proposed services, provide sufficiently trained and experienced
            professional staff, and evaluate the performance of the programs. Mississippi State
            Department of Health staff shall use guidelines presented in Optimal Resources for
            Examination of the Heart and Lungs: Cardiac Catheterization and Radiographic
            Facilities, published under the auspices of the Inter-Society Commission for Heart
            Disease Resources, as resource materials when reviewing these items in an application.




Chapter 5 – Acute Care                              68                             2011 State Health Plan
      5.    Staff Residency: The applicant shall certify that medical staff performing diagnostic
            cardiac catheterization procedures shall reside within forty-five (45) minutes normal
            driving time of the facility.

      6.    Recording and Maintenance of Data: Applicants shall provide, as required under
            licensure standards, written assurance that they will record and maintain utilization data
            for diagnostic cardiac catheterization procedures (e.g., morbidity data, number of
            diagnostic cardiac catheterization procedures performed, and mortality data, all reported
            by race, sex, and payor status) and make such data available to the Mississippi State
            Department of Health annually.

      7.    Referral Agreement: An applicant proposing the establishment of diagnostic cardiac
            catheterization services only shall document that a formal referral agreement with a
            facility for the provision of emergency cardiac services (including open-heart surgery)
            will be in place and operational at the time of the inception of cardiac catheterization
            services.

      8.    Patient Selection: An applicant proposing to provide diagnostic cardiac catheterization
            services must (a) delineate the steps which will be taken to insure that high-risk or
            unstable patients are not catheterized in the facility, and (b) certify that therapeutic cardiac
            catheterization services will not be performed in the facility unless and until the applicant
            has received CON approval to provide therapeutic cardiac catheterization services.

      9.    Regulatory Approval: Before utilizing or providing the equipment or service, the
            applicant desiring to provide the diagnostic cardiac catheterization equipment or service
            shall have CON approval or written evidence that the equipment or service is exempt from
            CON approval as determined by the Mississippi State Department of Health. Each
            specified piece of equipment must be exempt from or have CON approval.


115.04     Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control
           of Therapeutic Cardiac Catheterization Equipment and/or the Offering Of
           Therapeutic Cardiac Catheterization Services

      The Mississippi State Department of Health will review applications for a Certificate of Need
      for the acquisition or otherwise control of therapeutic cardiac catheterization equipment and/or
      the offering of therapeutic cardiac catheterization services under the applicable statutory
      requirements of Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as
      amended. The MSDH will also review applications for Certificate of Need according to the
      general criteria listed in the Mississippi Certificate of Need Review Manual; all adopted rules,
      procedures and plans of the Mississippi State Department of Health; and the specific criteria
      and standards listed below.

      The acquisition or otherwise control of therapeutic cardiac catheterization equipment is
      reviewable if the equipment costs exceed $1,500,000. The offering of therapeutic cardiac
      catheterization services is reviewable if the proposed provider has not provided those services
      on a regular basis within the period of twelve (12) months prior to the time such services would
      be offered.




2011 State Health Plan                                69                            Chapter 5 – Acute Care
      1.   Need Criterion: The applicant shall document a minimum population base of
           100,000 in the CC/OHSPA where the proposed therapeutic cardiac catheterization
           equipment/service is to be located. Division of Health Planning and Resource
           Development population projections shall be used.

      2.   Minimum Procedures: An applicant proposing the establishment of therapeutic cardiac
           catheterization services shall demonstrate that the proposed equipment/service utilization
           will be a minimum of 450 cardiac catheterizations, both diagnostic and therapeutic, per
           year by its third year of operation. An applicant proposing the establishment of therapeutic
           cardiac catheterization services who presently offers only diagnostic cardiac
           catheterization may include in its demonstration of a minimum of 450 cardiac
           catheterizations per year the number of diagnostic catheterizations that it performs.

      3.   Impact on Existing Providers: An applicant proposing to acquire or otherwise control
           therapeutic cardiac catheterization equipment and/or offer therapeutic cardiac
           catheterization services shall document that each existing unit which is (a) in the
           CC/OHSPA and (b) within 45 miles of the applicant, has been utilized for a minimum of
           450 procedures (both diagnostic and therapeutic) per year for the two most recent years as
           reflected in data supplied to and/or verified by the Mississippi State Department of Health.
           No hospital owned and/or operated by the state or its agencies shall be considered an
           existing unit in the CC/OHSPA under this section. The Mississippi State Department of
           Health may collect and consider any additional information it deems essential, including
           information regarding access to care, to render a decision regarding any application.

      4.   Staffing Standards: The applicant shall document that it has, or can obtain, the ability to
           administer the proposed services, provide sufficiently trained and experienced
           professional staff, and evaluate the performance of the programs. Mississippi State
           Department of Health staff shall use guidelines presented in Optimal Resources for
           Examination of the Heart and Lungs: Cardiac Catheterization and Radiographic
           Facilities, published under the auspices of the Inter-Society Commission for Heart
           Disease Resources, as resource materials when reviewing these items in an application.

      5.   Staff Residency: The applicant shall certify that medical staff performing therapeutic
           cardiac catheterization procedures shall reside within forty-five (45) minutes normal
           driving time of the facility.

      6.   Recording and Maintenance of Data: Applicants shall provide, as required under
           licensure standards, written assurance that they will record and maintain separate
           utilization data for diagnostic and therapeutic cardiac catheterization procedures (e.g.,
           morbidity data, number of diagnostic and therapeutic cardiac catheterization procedures
           performed and mortality data, all reported by race, sex and payor status) and make that
           data available to the Mississippi State Department of Health annually.

      7.   Open-Heart Surgery: An applicant proposing the establishment of therapeutic cardiac
           catheterization services shall document that open-heart surgery services are available or
           will be available on-site where the proposed therapeutic cardiac catheterization services
           are to be offered before such procedures are performed.

      8.   Regulatory Approval: Before utilizing or providing the equipment or service, the
           applicant desiring to provide the cardiac catheterization equipment or service shall have
           CON approval or written evidence that the equipment or service is exempt from CON


Chapter 5 – Acute Care                             70                             2011 State Health Plan
            approval as determined by the Mississippi State Department of Health. Each specified
            piece of equipment must be exempt from or have CON approval.

      9.    Applicants Providing Diagnostic Catheterization Services: An applicant proposing the
            establishment of therapeutic cardiac catheterization services, who is already an existing
            provider of diagnostic catheterization services, shall demonstrate that its diagnostic
            cardiac catheterization unit has been utilized for a minimum of 300 procedures per year
            for the two most recent years as reflected in the data supplied to and/or verified by the
            Mississippi State Department of Health.




2011 State Health Plan                              71                           Chapter 5 – Acute Care
OPEN-HEART SURGERY SERVICES
116 Open-Heart Surgery

   Open-heart surgery, defined as any surgical procedure in which a heart-lung machine is used to
   maintain cardiopulmonary functioning, involves a number of procedures, including valve
   replacement, repair of cardiac defects, coronary bypass, heart transplantation, and artificial heart
   implant.

   Section 41-7-191(1)(d), Mississippi Code of 1972, as amended, requires Certificate of Need
   review for the establishment and/or offering of open-heart surgery services if the proposed
   provider has not offered such services on a regular basis within 12 months prior to the time the
   services would be offered.

   Table 5-11 presents the utilization of existing facilities. Map 5-2 in the Open Heart Surgery
   criteria and standards section shows the Cardiac Catheterization/Open-Heart Surgery Planning
   Areas (CC/OHSPAs) and the location of existing services.




2011 State Health Plan                              75                            Chapter 5 – Acute Care
                                          Table 5-11
                    Number of Open-Heart Surgeries by Facility and Type
          By Cardiac Catheterization/Open Heart Surgery Planning Area (CC/OHSPA)
                                     FY 2008 and FY 2009
                                                                                             Number of
                                                      Number of Adult       Number of      Pediatric Heart
                 Facility                 County        Open-Heart        Pediatric Open- Procedures (Less
                                                        Procedures       Heart Procedures   Open-Heart)
                                                      2008      2009      2008    2009     2008      2009
             CC/OHSPA 1                                  213      239        0       0       0         0
Baptist Memorial Hospital - DeSoto     DeSoto            213      239        0       0       0         0
             CC/OHSPA 2                                1,022      910        0       0       0         0
Magnolia Regional Medical Center       Alcorn            208      192        0       0       0         0
North Miss Medical Center              Lee               814      718        0       0       0         0
              CC/OHSPA 3                                  75       69        0       0       0         0
Delta Regional Medical Center          Washington         75       69        0       0       0         0
           CC/OHSPA 4                                    167      155        0       0       0         0
BMH-Golden Triangle                    Lowndes            42        42       0        0       0        0
BMH-North Mississippi                  Lafayette         125       113       0        0       0        0
              CC/OHSPA 5                                 863       781      53       29      41       18
Central Miss Medical Center            Hinds              75        48       0        0       0        0
Miss Baptist Medical Center            Hinds             224       274       0        0       0        0
River Region Health System             Warren             55        89       0        0       0        0
St. Dominic Hospital                   Hinds             285       256       0        0       0        0
University Hospital & Clinics          Hinds             224       114      53       29      41       18
             CC/OHSPA 6                                  195       171       0        0       0        0
Anderson Medical Center                Lauderdale        134       133       0        0       0        0
Rush Foundation Hospital               Lauderdale         61        38       0        0       0        0
             CC/OHSPA 7                                  101       131       0        0       0        0
Southwest Miss Regional Medl Center    Pike              101       131       0        0       0        0
              CC/OHSPA 8                                 739       690       0        0       0        0
Forrest General Hospital               Forrest           607       575       0        0       0        0
Wesley Medical Center                  Lamar             132       115       0        0       0        0
              CC/OHSPA 9                                 410       433       0        0       0        0
Memorial Hospital at Gulfport          Harrison          243       216       0        0       0        0
Ocean Springs Hospital                 Jackson            98       154       0        0       0        0
Singing River Hospital                 Jackson            69        63       0        0       0        0
State Total                                            3,785     3,579      53       29      41       18

Sources: Applications for Renewal of Hospital License for Calendar Years 2009 and 2010, and Fiscal Years
2008 and 2009 Annual Hospital Reports




Chapter 5 – Acute Care                                76                             2011 State Health Plan
116.01     Policy Statement Regarding Certificate of Need Applications for the Acquisition of
           Open-Heart Surgery Equipment and/or the Offering of Open-Heart Surgery Services

      1.    Service Areas: The need for open-heart surgery equipment/services shall be determined
            using the nine designated Cardiac Catheterization/Open-Heart Surgery Planning Areas
            (CC/OHSPAs) presented in this chapter of the Plan. Map 5-2 shows the CC/OHSPAs.

      2.    CC/OHSPA Need Determination: The need for open-heart surgery equipment/services
            within a given CC/OHSPA shall be determined independently of all other CC/OHSPAs.

      3.    Pediatric Open-Heart Surgery: Because the number of pediatric patients requiring
            open-heart surgery is relatively small, the provision of open-heart surgery for neonates,
            infants, and young children shall be restricted to those facilities currently providing the
            service.

      4.    Present Utilization of Open-Heart Surgery Equipment/Services: The Mississippi State
            Department of Health shall consider utilization of existing open-heart surgery equipment/
            services and the presence of valid CONs for open-heart surgery equipment/services within
            a given CC/OHSPA when reviewing CON applications. The MSDH shall not consider
            utilization of equipment/services at any hospital owned and/or operated by the state or its
            agencies when reviewing CON applications. The Mississippi State Department of Health
            may collect and consider any additional information it deems essential, including
            information regarding access to care, to render a decision regarding any application.

      5.    CON Application Analysis: At its discretion, the Department of Health may use market
            share analysis and other methodologies in the analysis of a CON application for the
            acquisition or otherwise control of open-heart surgery equipment and/or the offering of
            open-heart surgery services. The Department shall not rely upon market share analysis or
            other statistical evaluations if they are found inadequate to address access to care
            concerns.

      6.    Minimum CC/OHSPA Population: A minimum population base of 100,000 in a
            CC/OHSPA (as projected by the Division of Health Planning and Resource Development)
            is required before such equipment/services may be considered. The total population within
            a given CC/OHSPA shall be used when determining the need for services. Population
            outside an applicant's CC/OHSPA will be considered in determining need only when the
            applicant submits adequate documentation acceptable to the Mississippi State Department
            of Health, such as valid patient origin studies.

      7.    Minimum Caseload: Applicants proposing to offer adult open-heart surgery services must
            be able to project a caseload of at least 150 open-heart surgeries per year.

      8.    Residence of Medical Staff: Open-heart surgery must be under the control of and
            performed by personnel living and working within the specific hospital area. No site shall
            be approved for the provision of services by traveling teams.




2011 State Health Plan                               77                            Chapter 5 – Acute Care
116.02     Certificate of Need Criteria and Standards for the Acquisition or Otherwise Control
           of Open-Heart Surgery Equipment and/or the Offering of Open-Heart Surgery
           Services

      The Mississippi State Department of Health will review applications for a Certificate of Need
      for the acquisition or otherwise control of open-heart surgery equipment and/or the offering of
      open-heart surgery services under the applicable statutory requirements of Sections 41-7-173,
      41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review
      applications for Certificate of Need according to the general criteria listed in the Mississippi
      Certificate of Need Review Manual; all adopted rules, procedures and plans of the Mississippi
      State Department of Health; and the specific criteria and standards listed below.

      The acquisition or otherwise control of open-heart surgery equipment is reviewable if the
      equipment cost in excess of $1,500,000. The offering of open-heart surgery services is
      reviewable if the proposed provider has not provided those services on a regular basis within
      twelve (12) months prior to the time such services would be offered.

      1.    Need Criterion: The applicant shall document a minimum population base of
            100,000 in the CC/OHSPA where the proposed open-heart surgery
            equipment/service is to be located. Division of Health Planning and Resource
            Development population projections shall be used.

      2.    Minimum Procedures: The applicant shall demonstrate that it will perform a minimum of
            150 open-heart surgeries per year by its third year of operation.

      3.    Impact on Existing Providers: An applicant proposing to acquire or otherwise control
            open-heart surgery equipment and/or offer open-heart surgery services shall document that
            each facility offering open-heart surgery services which is (a) in the CC/OHSPA and (b)
            within 45 miles of the applicant, has performed a minimum of 150 procedures per year for
            the two most recent years as reflected in data supplied to and/or verified by the
            Mississippi State Department of Health. No hospital owned and/or operated by the state or
            its agencies shall be considered an existing unit in the CC/OHSPA under this section. The
            Mississippi State Department of Health may collect and consider any additional
            information it deems essential, including information regarding access to care, to render a
            decision regarding any application.

      4.    Staffing Standards: The applicant shall document that it has, or can obtain, the ability to
            administer the proposed services, provide sufficiently trained and experienced
            professional staff, and evaluate the performance of the programs. Department of Health
            staff shall use guidelines presented in Optimal Resources for Examination of the Heart
            and Lungs: Cardiac Catheterization and Radiographic Facilities, published under the
            auspices of the Inter-Society Commission for Heart Disease Resources, and Guidelines
            and Indications for Coronary Artery Bypass Graft Surgery: A Report of the American
            College of Cardiology/American Heart Association Task Force on Assessment of
            Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Coronary
            Artery Bypass Graft Surgery), published under the auspices of the American College of
            Cardiology, as resource materials when reviewing these items in an application.

      5.    Staff Residency: The applicant shall certify that medical staff performing open-heart
            surgery procedures shall reside within forty-five (45) minutes normal driving time of the



Chapter 5 – Acute Care                              78                             2011 State Health Plan
            facility. The applicant shall document that proposed open-heart surgery procedures shall
            not be performed by traveling teams.

      6.    Recording and Maintenance of Data: Applicants shall provide, as required under
            licensure standards, written assurance that they will record and maintain utilization data
            for open-heart surgeries (e.g., morbidity data, number of open-heart surgeries performed
            and mortality data, all reported by race, sex, and payor status) and make such data
            available to the Mississippi State Department of Health annually.

      7.    Regulatory Approval: Before utilizing or providing the equipment or service, the
            applicant desiring to provide the open-heart surgery equipment or service shall have CON
            approval or written evidence that the equipment or service is exempt from CON approval
            as determined by the Mississippi State Department of Health. Each specified piece of
            equipment must be exempt from or have CON approval.




2011 State Health Plan                              79                           Chapter 5 – Acute Care
                                             Map 5-2
                            Cardiac Catherization/Open Heart Surgery
                                  Planning Areas (CC/OHSPA)
                         and Location of Existing/CON-Approved Services




Chapter 5 – Acute Care                          80                        2011 State Health Plan
117 Trauma

      Trauma is the leading cause of death for all age groups in Mississippi from birth to age 44.
      Serious injury and death resulting from trauma events such as vehicle crashes, falls, and
      firearms claim 2,000 lives and disable 6,000 Mississippians each year. Trauma victims require
      immediate, expert attention.


117.01    Mississippi Trauma Care System

          Through the Trauma Care Plan, MSDH has designated seven trauma care regions; each
          incorporated as a 501c-3 organization and contracts with the MSDH to develop and
          implement a Regional Trauma Plan. The Mississippi Trauma Care System Plan includes the
          seven regional plans, and allows for referral agreements between trauma facilities and for
          trauma patients to be transported to the ―most appropriate‖ trauma facility for their injuries.

          Trauma facility designation levels set specific criteria and standards of care that guide
          hospital and emergency personnel in determining the level of care a trauma victim needs
          and whether that hospital can care for the patient or transfer the patient to a Trauma Center
          that can administer more definitive care.

          Level I Trauma Centers must have a full range of trauma capabilities, including an
          emergency department, a full-service surgical suite, intensive care unit, and diagnostic
          imaging. Level I centers must have a residency program, ongoing trauma research, and
          provide 24-hour trauma service. These hospitals provide a variety of other services to
          comprehensively care for both trauma patients and medical patients. Level I Trauma
          Centers act as referral facilities for Level II, III, and IV Trauma Centers. The University of
          Mississippi Medical Center (UMMC) in Jackson is the only Level 1 facility in the state.
          Two Level I Trauma Centers border the northern and southeastern part of the state and are
          located in Tennessee and Alabama.

          Level II Trauma Centers must be able to provide initial care to the severely injured
          patient. These facilities must have a full range of trauma capabilities, including an
          emergency department, a full service surgical suite, an intensive care unit, and diagnostic
          imaging. Level II Trauma Centers act as referral facilities for Level III and IV Trauma
          Centers.

          Level III Trauma Centers must offer continuous general surgical coverage and have the
          ability to manage the initial care of many injured patients. Level III Trauma Centers must
          also provide continuous orthopedic coverage. Transfer agreements must be in place with
          Level I and II Trauma Centers for patients that exceed the Level III Trauma Center’s
          resources.

          Level IV Trauma Centers provide initial evaluation and assessment of injured patients.
          Most patients will require transfer to facilities with more resources dedicated to providing
          optimal care for the injured patients. Level IV Trauma Centers must have transfer
          agreements in place with Level I, II, and III Trauma Centers.




2011 State Health Plan                              81                            Chapter 5 – Acute Care
117.02    Current Status of Mississippi Trauma Care

          Uncompensated medical services, staff shortages including both surgeons and nurses, and
          restrictions on resident hours have combined to create reductions in both the number of
          available trauma beds and the number of trauma centers in Mississippi (and nationally),
          despite the funding available from the Mississippi Trauma Care Trust Fund for hospitals
          participating in the Mississippi Trauma Care System. The state’s only Level 1 trauma
          center, University of Mississippi Medical Center , has had difficulties filling trauma
          positions and has been forced to reduce the number of trauma beds available because of the
          staff shortages. Nationally, there are increasing demands for federal funds to be designated
          toward trauma systems to offset these trends in hospitals facing staffing problems getting
          out of trauma care or reducing the number of trauma beds available. Until federal funds are
          provided, states are left to take up the slack in providing assistance to a growing problem in
          trauma care.

          To increase participation in the trauma care system, the Mississippi Legislature amended
          the EMS Act of 1974 (Miss. Code Ann. §63-13-11) in 2008. It required MSDH to develop
          regulations to compel all licensed acute care hospitals to participate in the Mississippi
          Statewide Trauma System (pay or play). Hospitals must participate in one of the following
          four levels: Level I, Level II, Level III, or Level IV. Each hospital’s capabilities must be
          reviewed by the Mississippi State Department of Health and the highest trauma designation
          level will be determined by the Department.

          The amended legislation also eliminated regulations which allowed hospitals to participate
          in the system on a volunteer basis. Hospitals that refuse to participate at the appropriate
          level in the system must pay an annual mandatory assessment fee to the Mississippi Trauma
          Care System.

          For more information on the Trauma Care System or trauma in general, please see the
          MSDH trauma website at: http://www.ems.doh.ms.gov/trauma/index.html

          Map 5-3 demonstrates Mississippi’s seven trauma regions, and the location of each trauma
          care center.


117.03    Emergency Medical Services

   Emergency medical services (EMS) are health care services delivered under emergency conditions
   that occur as a result of the patient’s condition, natural disasters, or other situations. Emergency
   medical services are provided by public, private, or non-profit entities with the authority and the
   resources to effectively administer the services.

   Approximately 50 percent of the state’s 82 counties presently participate in regional EMS
   programs. Counties not participating are left to provide services on an individual basis.




Chapter 5 – Acute Care                              82                            2011 State Health Plan
                                      Map 5-3
                         Mississippi Trauma Care Regions




2011 State Health Plan               83                    Chapter 5 – Acute Care
      CHAPTER 6
COMPREHENSIVE MEDICAL
REHABILITATION SERVICES
.
Chapter 6 Comprehensive Medical Rehabilitation Services

100 Comprehensive Medical Rehabilitation Services

   Comprehensive medical rehabilitation (CMR) services are defined as intensive care providing a
   coordinated multidisciplinary approach to patients with severe physical disabilities that require an
   organized program of integrated services. Level I facilities offer a full range of CMR services to
   treat disabilities such as spinal cord injury, brain injury, stroke, congenital deformity, amputations,
   major multiple trauma, polyarthritis, fractures of the femur, and neurological disorders. Level II
   facilities offer CMR services to treat disabilities other than spinal cord injury, congenital
   deformity, and brain injury.

   The bed capacity, number of discharges, average length of stay, and occupancy rates for Level I
   and Level II CMR facilities are listed in Tables 6-1 and 6-2, respectively.

                                                   Table 6-1
                                       Hospital-Based Level I CMR Units
                                                    FY 2009

                                                        Licensed        Average   Average
                                                          Bed            Daily    Length of Occupancy
    Facilities                                          Capacity        Census      Stay    Rate (%)
    Baptist Memorial Hospital - DeSoto                     30            16.59     12.84       55.80
    Delta Regional Medical Center                          24            8.72      12.94       36.31
    Forrest General Hospital                               24            17.06     13.56       71.08
    Memorial Hospital at Gulfport                          33            18.11     13.17       54.87
    Mississippi Methodist Rehab Center                     80            49.82     15.70       62.27
    North Miss Medical Center                              30            20.44     16.69       68.15
    University Hospital and Health System                  25            16.79     15.79       67.16
    State Total                                           246            21.08     14.38       59.38
    Source: 2009 Report on Hospitals, Mississippi State Department of Health




Chapter 6 – Comprehensive Medical
Rehabilitation Services                                     1                         2011 State Health Plan
                                                   Table 6-2
                                       Hospital-Based Level II CMR Units
                                                    FY 2009

                                                                         Average
                                                             Bed          Daily        Average      Occupancy
    Facility                                               Capacity      Census      Length of Stay Rate (%)
    Baptist Memorial Hospital - North Miss                    13          7.93          13.79          61.10
    Greenwood Leflore Hospital                                20          7.77          12.91          38.84
    Natchez Regional Medical Center                           20          7.58          16.20          37.88
    Northwest Miss Regional Med Center                        14          3.01          10.87          21.49
    Riley Memorial Hospital                                   20          15.45         13.44          77.23
    Singing River Hospital                                    20          14.67         12.69          73.29
    TOTALS                                                   107          8.06          11.41          44.26
    Source: 2009 Report on Hospitals, Mississippi State Department of Health



101 The Need for Comprehensive Medical Rehabilitation Services

   A total of 246 Level I and 107 Level II rehabilitation beds are operational in Mississippi during
   FY 2009. Map 6-3 at the end of this chapter shows the location of all CMR facilities in the state.
   The state as a whole serves as a single service area when determining the need for comprehensive
   medical rehabilitation beds/services. Based on the bed need formula found in the criteria and
   standards section of this chapter, Mississippi is currently over-bedded 8 by Level I beds but needs
   78 additional Level II CMR beds.


102 The Need for Children's Comprehensive Medical Rehabilitation Services

   No universally accepted methodology exists for determining the need of children's comprehensive
   medical rehabilitation services. The bed need methodology in the previous section addresses need
   for all types of comprehensive medical rehabilitation beds, including those for children.




                                                                               Chapter 6 – Comprehensive Medical
2011 State Health Plan                                      2                               Rehabilitation Services
    CERTIFICATE OF NEED
  CRITERIA AND STANDARDS
            FOR
  COMPREHENSIVE MEDICAL
REHABILITATION BEDS/SERVICES
103 Certificate of Need Criteria and Standards for Comprehensive Medical
    Rehabilitation Beds/Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


   103.01      Policy Statement Regarding Certificate of Need Applications for Comprehensive
               Medical Rehabilitation Beds/Services

          1.    Definition: Comprehensive Medical Rehabilitation Services provided in a freestanding
                comprehensive medical rehabilitation hospital or comprehensive medical rehabilitation
                distinct part unit are defined as intensive care providing a coordinated multidisciplinary
                approach to patients with severe physical disabilities that require an organized program
                of integrated services. These disabilities include: stroke, spinal cord injury, congenital
                deformity, amputation, major multiple trauma, fractures or the femur (hip fracture),
                brain injury, polyarthritis, including rheumatoid arthritis, or neurological disorders,
                including multiple sclerosis, motor neuron disease, polyneuropathy, muscular
                dystrophy, and Parkinson’s Disease.

          2.    Planning Areas: The state as a whole shall serve as a single planning area for
                determining the need of comprehensive medical rehabilitation beds/services.

          3.    Comprehensive Medical Rehabilitation Services:

                Level I - Level I comprehensive medical rehabilitation providers may provide treatment
                services for all rehabilitation diagnostic categories.

                Level II - Level II comprehensive medical rehabilitation providers may provide
                treatment services for all rehabilitation diagnostic categories except: (1) spinal cord
                injuries, (2) congenital deformity, and (3) brain injury.

          4.    CMR Need Determination: The Mississippi State Department of Health shall
                determine the need for Level I comprehensive rehabilitation beds/services based upon
                a formula of 0.08 beds per 1,000 population for the state as a whole.

               The Mississippi State Department of Health shall determine need for Level II
               comprehensive medical rehabilitation beds/services based upon a formula of 0.0623
               beds per 1,000 population for the state as a whole. Table 6-3 shows the current need for
               comprehensive medical rehabilitation beds.

          5.    Present Utilization of Rehabilitation Services: When reviewing CON applications, the
                MSDH shall consider the utilization of existing services and the presence of valid
                CONs for services.


                                                                         Chapter 6– Comprehensive Medical
2011 State Health Plan                                 5                             Rehabilitation Services
         6.   Minimum Sized Facilities/Units: Freestanding comprehensive medical rehabilitation
              facilities shall contain not less than 60 beds. Hospital-based Level I comprehensive
              medical rehabilitation units shall contain not less than 20 beds. If the established
              formula reveals a need for more than ten beds, the MSDH may consider a 20 30-bed
              (minimum sized) unit for approval. Hospital-based Level II comprehensive medical
              rehabilitation facilities are limited to a maximum of 20 beds. New Level II
              rehabilitation units shall not be located within a 45 mile radius of any other CMR
              facility.

         7.   Expansion of Existing CMR Beds: Before any additional CMR beds, for which CON
              review is required, are approved for any facility presently having CMR beds, the
              currently licensed CMR beds at said facility shall have maintained an occupancy rate
              of at least 80 percent for the most recent 12-month licensure reporting period or at least
              70 percent for the most recent two years.

         8.   Priority Consideration: When reviewing two or more competing CON applications,
              the MSDH shall use the following factors in the selection process, including, but not
              limited to, a hospital having a minimum of 160 licensed acute care beds as of January
              1, 2000; the highest average daily census of the competing applications; location of
              more than 45 mile radius from an existing provider of comprehensive medical
              rehabilitation services; proposed comprehensive range of services; and the patient base
              needed to sustain a viable comprehensive medical rehabilitation service.

         9.   Children's Beds/Services: Should a CON applicant intend to serve children, the
              application shall include a statement to that effect.

        10.   Other Requirements: Applicants proposing to provide CMR beds/services shall meet
              all requirements set forth in CMS regulations as applicable, except where additional or
              different requirements, as stated in the State Health Plan or in the licensure
              regulations, are required. Level II comprehensive medical rehabilitation units are
              limited to a maximum size of 20 30 beds and new Level II rehabilitation units must be
              more than a 45 mile radius from any other Level I or Level II rehabilitation facility.

        11.   Enforcement: In any case in which the MSDH finds a Level II Provider has failed to
              comply with the diagnosis and admission criteria as set forth above, the provider shall
              be subject to the sanctions and remedies as set forth in Section 41-7-209 of the
              Mississippi Code of 1972, as amended, and other remedies available to the MSDH in
              law or equity.

        12.   Effective July 1, 1994, no health care facility shall be authorized to add any beds or
              convert any beds to another category of beds without a Certificate of Need under the
              authority of Section 41-7-191(1)(c), unless there is a projected need for such beds in
              the planning district in which the facility is located.

        13.   Effective March 4, 2003, if a health care facility has voluntarily delicensed some of its
              existing bed complement, it may later relicense some or all of its delicensed beds
              without the necessity of having to acquire a Certificate of Need. The Department of
              Health shall maintain a record of the delicensing health care facility and its voluntarily
              delicensed beds and continue counting those beds as part of the state’s total bed count
              for health care planning purposes.



Chapter 6 – Comprehensive Medical
Rehabilitation Services                             6                              2011 State Health Plan
   103.02      Certificate of Need Criteria and Standards for Comprehensive Medical
               Rehabilitation Beds/Services

   The MSDH will review applications for a CON for the establishment, offering, or expansion of
   comprehensive medical rehabilitation beds and/or services under the statutory requirements of
   Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code 1972, Annotated, as amended. The
   MSDH will also review applications for Certificate of Need according to the general criteria listed
   in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of
   the Mississippi State Department of Health; and the specific criteria and standards listed below.

   In addition, comprehensive rehabilitation services are reviewable if the proposed provider has not
   provided such services on a regular basis within twelve (12) months prior to the time such services
   would be offered. The twenty (20) bed hospital-based comprehensive medical rehabilitation
   facilities which are operational or approved on January 1, 2001, are grandfathered and shall not
   be required to obtain a Certificate of Need as long as the services are provided continuously by
   those facilities and are limited to the diagnoses set forth below for Level II comprehensive medical
   rehabilitation facilities.

          1.    Need Criterion:

                 a. New/Existing Comprehensive Medical Rehabilitation Beds/Services: The need
                    for Level I comprehensive medical rehabilitation beds in the state shall be
                    determined using a methodology of 0.08 beds per 1,000 population. The state as a
                    whole shall be considered as a single planning area.

                     The need for Level II comprehensive medical rehabilitation beds in the state shall
                     be determined using a methodology of 0.0623 comprehensive medical
                     rehabilitation beds per 1,000 population. The state as a whole shall be considered
                     a planning area.

                 b. Projects which do not involve the addition of any CMR beds: The applicant
                    shall document the need for the proposed project. Documentation may consist of,
                    but is not necessarily limited to, citing of licensure or regulatory code deficiencies,
                    institutional long-term plans (duly adopted by the governing board),
                    recommendations made by consultant firms, and deficiencies cited by
                    Accreditation Agencies (JCAHO, CAP).

                 c. Projects which involve the addition of beds: The applicant shall document the
                    need for the proposed project. Exception: Notwithstanding the service specific
                    need requirements as stated in "a" above, the MSDH may approve additional beds
                    for facilities which have maintained an occupancy rate of at least 80 percent for the
                    most recent 12-month licensure reporting period or at least 70 percent for the most
                    recent two (2) years. An applicant which is proposing to convert from a current
                    Level II CMR status to a Level I status, as provided in Criterion 1(e) below, may
                    also apply for additional CMR beds as part of the same application and, if
                    approved, all CMR beds in the unit may be operated as Level I CMR beds.

                 d. Level II Trauma Centers: The applicant shall document the need for the
                    proposed CMR project. Exception: Notwithstanding the forty-five (45) mile radius
                    distance requirement from an existing CMR provider, the MSDH may approve the
                    establishment of a 20-bed Level II CMR unit for any hospital without CMR beds


                                                                         Chapter 6– Comprehensive Medical
2011 State Health Plan                                7                              Rehabilitation Services
                  which holds Level II Trauma care designation on July 1, 2003, as well as on the
                  date the Certificate of Need application is filed.

           e. Conversion of Level II CMR Unit to Level I CMR Unit: Notwithstanding any other
              policy statement, standard or criterion, an existing Level II CMR unit may convert to a
              Level I CMR unit if the Level II facility meets the following requirements:

              (i)       The Level II CMR unit demonstrates high utilization by documenting that it
              has maintained an occupancy rate of at least 80 percent for the most recent 12-month
              licensure reporting period or at least 70 percent for the most recent two (2) years.

              (ii)      The Level II CMR unit establishes the need for Level I CMR status by
              documenting that the facility expects to admit a minimum of 50 patients annually with
              one or more of the following rehabilitation diagnostic categories: spinal cord injuries,
              congenital deformity, and/or brain injury. This documentation may include, without
              limitation, the Level II CMR unit’s patient data or any other data or documentation
              acceptable to the State Department of Health.

              (iii)     The Level II CMR unit shall document compliance with the standards for
              Level I CMR units set forth below in Criterion 2 (Treatment and Programs) and
              Criterion 3 (Staffing and Services).



         2.   Applicants proposing to establish Level I comprehensive medical rehabilitation
              services shall provide treatment and programs for one or more of the following
              conditions:

               a. stroke,

               b. spinal cord injury,

               c. congenital deformity,

               d. amputation,

               e. major multiple trauma,

               f. fractures of the femur (hip fracture),

               g. brain injury,

               h. polyarthritis, including rheumatoid arthritis, or

               i. neurological disorders, including multiple sclerosis, motor neuron disease,
                  polyneuropathy, muscular dystrophy, and Parkinson's Disease.

                Applicants proposing to establish Level II comprehensive medical rehabilitation
                services shall be prohibited from providing treatment services for the following
                rehabilitation diagnostic categories: (1) spinal cord injury, (2) congenital deformity,
                and (3) brain injury.


Chapter 6 – Comprehensive Medical
Rehabilitation Services                             8                              2011 State Health Plan
                 Facilities providing Level I and Level II comprehensive medical rehabilitation
                 services shall include on their Annual Report of Hospitals submitted to the MSDH
                 the following information: total admissions, average length of stay by diagnosis,
                 patient age, sex, race, zip code, payor source, and length of stay by diagnosis.

          3.   Staffing and Services

                a. Freestanding Level I Facilities

                      i.   Shall have a Director of Rehabilitation who:

                            (1)   provides services to the hospital and its inpatient clientele on a
                                  full-time basis;

                            (2)   is a Doctor of Medicine or Osteopathy licensed under state law to
                                  practice medicine or surgery; and

                            (3)   has had, after completing a one-year hospital internship, at least two
                                  years of training in the medical management of inpatients requiring
                                  rehabilitation services.

                     ii.   The following services shall be provided by full-time designated staff:

                            (1)   speech therapy

                            (2)   occupational therapy

                            (3)   physical therapy

                            (4)   social services

                    iii.   Other services shall be provided as required, but may be by consultant or on
                           a contractual basis.

                b. Hospital-Based Units

                      i.   Both Level I and Level II hospital-based units shall have a Director of
                           Rehabilitation who:

                            (1)   is a Doctor of Medicine or Osteopathy licensed under state law to
                                  practice medicine or surgery;

                            (2)    has had, after completing a one-year hospital internship, at least two
                                  years of training or experience in the medical management of
                                  inpatients requiring rehabilitation services; and

                            (3)   provides services to the unit and its inpatients for at least 20 hours
                                  per week.

                     ii.   The following services shall be available full time by designated staff:

                            (1)   physical therapy

                                                                        Chapter 6– Comprehensive Medical
2011 State Health Plan                                9                             Rehabilitation Services
                             (2)   occupational therapy

                             (3)   social services

                    iii.    Other services shall be provided as required, but may be by consultant or on
                            a contractual basis.


   103.03    Certificate of Need Criteria and Standards for Children's Comprehensive Medical
             Rehabilitation Beds/Services

   Until such time as specific criteria and standards are developed, the MSDH will review CON
   applications for the establishment of children's comprehensive medical rehabilitation services
   under the general criteria and standards listed in the Mississippi Certificate of Need Review
   Manual in effect at the time of submission of the application, and the preceding criteria and
   standards listed.


   103.04    Comprehensive Medical Rehabilitation Bed Need Methodology

   The determination of need for Level I CMR beds/services will be based on 0.08 beds per 1,000
   population in the state as a whole for the year 2010. Table 6-3 presents Level I CMR bed need.

   The determination of need for Level II CMR beds/services will be based on 0.0623 beds per 1,000
   population in the state as a whole for the year 2010. Table 6-3 presents Level II CMR bed need.

                                           Table 6-3
                           Comprehensive Medical Rehabilitation Bed Need
                                              2010


                           Estimated Population       Aproved CMR           CMR Beds
         Level                     2010                   Beds               Needed         Difference
    Level I                     2,975,551                246                   238                -8
    Level II                    2,975,551                107                   185                78
   Source: Applications for renewal of hospital license for Fiscal Year 2009; Mississippi Population
   Projections 2010, 2015, and 2020,. Center for Policy Research and Planning, Mississippi Institutions of
   Higher Learning, August 2005.




Chapter 6 – Comprehensive Medical
Rehabilitation Services                                10                               2011 State Health Plan
                                              Map 6-1
                                    Location of Comprehensive
                         Medical Rehabilitation Facilities Level I and Level II




                                                                     Chapter 6– Comprehensive Medical
2011 State Health Plan                              11                           Rehabilitation Services
.
     CHAPTER 7
OTHER HEALTH SERVICES
Chapter 7 Other Health Services
Other ambulatory health services consist of primary, specialty, and supportive medical services
provided on an outpatient basis, in contrast to services provided in the home or to persons who are
inpatients. The term ambulatory care implies that patients must travel to a location outside the home
to receive services that do not require an overnight hospital stay. This chapter describes several
organizations which provide ambulatory care in Mississippi. In addition, this chapter discusses home
health services in Mississippi.


100 Ambulatory Surgery Services

       During FY 2009, 73 of the state's medical/surgical hospitals reported a total of 287,546 general
       surgical procedures. This number included 173,680 ambulatory surgeries, a 1.00 percent
       increase of the 172,309 ambulatory surgeries performed in hospitals during 2008. The
       percentage of surgeries performed on an outpatient basis in hospitals has risen from 6.6 percent
       in 1981 to 60.4 percent in 2009. Table 7-1 displays hospital affiliated surgery data by general
       hospital service area.

       Mississippi licenses 19 freestanding ambulatory surgery facilities. Table 7-2 shows the
       distribution of facilities and related ambulatory surgery data. The 19 facilities reported 68,566
       procedures during fiscal year 2009. Total outpatient surgeries (hospitals and freestanding
       facilities combined) comprised 68.0 percent of all surgeries performed in the state. The number
       of procedures performed in freestanding facilities was 19.3 percent of total surgeries in 2009.

                                         Table 7-1
   Selected Hospital Affiliated Ambulatory Surgery Data by General Hospital Service Area
                                          FY 2009
                                                                                 Average1
                                                    Ambulatory                  Number of
                                                     Surgeries / Number of Surgical
   General       Total       Number Number of           Total      Operating Procedures
   Hospital   Number of          of   Ambulatory      Surgeries     Rooms /      per Day /
 Service Area Surgeries Hospitals Surgeries         (Percent of)     Suites        Suite
  Mississippi    287,546        73         173,680      60.4          423          2.72
       1            6,588       4            3,517      53.4           17          1.55
       2           32,808       6           20,835      63.5           42          3.12
       3           20,025       8           13,433      67.1           34          2.36
       4           27,129       8           17,809      65.6           40          2.71
       5           83,997       18          46,980      55.9          124          2.71
       6           24,122       8           16,442      68.2           43          2.24
       7           22,316       7           16,343      73.2           32          2.79
       8           24,140       5           12,250      50.7           39          2.48
       9           46,421       9           26,071      56.2           52          3.57
  1
   Based on 250 working days per year
  Source: Applications for Renewal of Hospital License for Calendar Year 2010 and FY 2009 Annual Hospital Report




2011 State Health Plan                                     1                    Chapter 7– Other Health Services
                                        Table 7-2
               Selected Freestanding Ambulatory Surgery Data by County
                                        FY 2009
Ambulatory                  Number of       Number of                   Number1 of
 Surgery                   Freestanding     Ambulatory    Number of       Surgical
 Planning                  Ambulatory        Surgeries    Operating    Procedures Per
   Area      County      Surgery Centers     Performed   Rooms/Suites Day/O.R. Suite
 (ASPAs)   Mississippi          19             68,566          75          3.66
     1     DeSoto               1               1,751           3          2.33
     2     Lee                  1               5,889           6          3.93
     4     Lafayette            1               3,403           4          3.40
     5     Hinds                4              21,000          19          4.42
     5     Rankin               1               2,504           5          2.00
     8     Forrest              4              17,105          15          4.56
     8     Jones                1               2,462           4          2.46
     9     Harrison             3              10,172          10          4.07
     9     Jackson              3               4,280           9          1.90

  1
      Based on 250 working days per year
  Source: Survey of individual ambulatory surgery centers conducted April 2010; Division of Health Planning and
  Resource Development, Mississippi State Department of Health




Chapter 7 – Other Health Services                           2                                 2011 State Health Plan
                                     Map 7-1
                         Ambulatory Surgery Planning Areas




2011 State Health Plan                   3               Chapter 7– Other Health Services
AMBULATORY SURGERY SERVICES
101 Certificate of Need Criteria and Standards for Ambulatory Surgery Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


   101.01    Policy Statement Regarding Certificate of Need Applications for Ambulatory
             Surgery Services

             1.   Ambulatory Surgery Planning Areas (ASPAs): The Mississippi State Department
                  of Health (MSDH) shall use the Ambulatory Surgery Planning Areas as outlined on
                  Map 7-1 of this Plan for planning and Certificate of Need (CON) decisions. The
                  need for ambulatory surgery facilities in any given ASPA shall be calculated
                  independently of all other ASPAs.

             2.   Ambulatory Surgery Facility Service Areas: An applicant's Ambulatory Surgery
                  Facility Service Area must have a population base of approximately 60,000 within
                  30 minutes normal driving time or 25 miles, whichever is greater, of the
                  proposed/established facility. Note: Licensure standards require a freestanding
                  facility to be within 15 minutes traveling time of an acute care hospital and a
                  transfer agreement with said hospital must be in place before a CON may be issued.
                  Additionally, the ambulatory surgery facility service area must have a stable or
                  increasing population.

             3.   Definitions: The Glossary of this Plan includes the definitions in the state statute
                  regarding ambulatory surgery services.

             4.   Surgeries Offered: The MSDH shall not approve single service ambulatory surgery
                  centers. Only multi-specialty ambulatory surgery center proposals may be approved
                  for a CON.

             5.   Minimum Surgical Operations: The minimum of 1,000 surgeries required to
                  determine need is based on five (5) surgeries per operating room per day x 5 days
                  per week x 50 weeks per year x 80 percent utilization rate.

             6.   Present Utilization of Ambulatory Surgery Services: The MSDH shall consider the
                  utilization of existing services and the presence of valid CONs for services within a
                  given ASPA when reviewing CON applications.

             7.   Optimum Capacity: The optimum capacity of an ambulatory surgery facility is 800
                  surgeries per operating room per year. The MSDH shall not issue a CON for the
                  establishment or expansion of an additional facility(ies) unless the existing facilities
                  within the ASPA have performed in aggregate at least 800 surgeries per operating
                  room per year for the most recent 12-month reporting period, as reflected in data


2011 State Health Plan                               7                   Chapter 7– Other Health Services
                  supplied to and/or verified by the MSDH. The MSDH may collect additional
                  information it deems essential to render a decision regarding any application.
                  Optimum capacity is based on four (4) surgeries per operating room per day x 5
                  days per week x 50 weeks per year x 80 percent utilization rate.

             8.   Conversion of Existing Service: Applications proposing the conversion of existing
                  inpatient capacity to hospital-affiliated ambulatory surgical facilities located within
                  the hospital shall receive approval preference over detached or freestanding
                  ambulatory surgical facilities if the applicant can show that such conversion is less
                  costly than new construction and if the application substantially meets other adopted
                  criteria.

             9.   Construction/Expansion of Facility: Any applicant proposing to construct a new
                  facility or major renovation to provide ambulatory surgery must propose to
                  build/renovate no fewer than two operating rooms.

            10.   Indigent/Charity Care: The applicant shall be required to provide a “reasonable
                  amount” of indigent/charity care as described in Chapter 1 of this Plan.

   101.02    Certificate of Need Criteria and Standards for Ambulatory Surgery Services

      The MSDH will review applications for a CON for new ambulatory surgery facilities, as
      defined in Mississippi law, under the statutory requirements of Sections 41-7-173, 41-7-191,
      and 41-7-193, Mississippi Code of 1972 Annotated, as amended. The MSDH will also review
      applications submitted for Certificate of Need in accordance with the rules and regulations in
      the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and plans of
      the Mississippi State Department of Health; and the specific criteria and standards listed below.

      The offering of ambulatory surgery services is reviewable if the proposed provider has not
      provided those services on a regular basis within twelve (12) months prior to the time such
      services would be offered. In addition, ambulatory surgery services require CON review when
      the establishment or expansion of the services involves a capital expenditure in excess of
      $2,000,000.

             1.   Need Criterion: The applicant shall demonstrate that the proposed
                  ambulatory surgery facility shall perform a minimum average of 1,000
                  surgeries per operating room per year.

             2.   The applicant must document that the proposed Ambulatory Surgery Facility
                  Service Area has a population base of approximately 60,000 within 30 minutes
                  travel time.

             3.   An applicant proposing to offer ambulatory surgery services shall document that the
                  existing facilities in the ambulatory surgery planning area have been utilized for a
                  minimum of 800 surgeries per operating room per year for the most recent 12-
                  month reporting period as reflected in data supplied to and/or verified by the
                  Mississippi State Department of Health. The MSDH may collect additional
                  information it deems essential to render a decision regarding any application.

             4.   The applicant must document that the proposed program shall provide a full range
                  of surgical services in general surgery.



Chapter 7 – Other Health Services                    8                            2011 State Health Plan
             5.   The applicant must provide documentation that the facility will be economically
                  viable within two years of initiation.

             6.   The proposed facility must show support from the local physicians who will be
                  expected to utilize the facility.

             7.   Medical staff of the facility must live within a 25-mile radius of the facility.

             8.   The proposed facility must have a formal agreement with a full service hospital to
                  provide services which are required beyond the scope of the ambulatory surgical
                  facility's programs. The facility must also have a formal process for providing
                  follow-up services to the patients (e.g., home health care, outpatient services)
                  through proper coordination mechanisms.

             9.   Indigent/Charity Care: The applicant shall affirm that the applicant will provide a
                  “reasonable amount” of indigent/charity care by stating the amount of
                  indigent/charity care the applicant intends to provide.




2011 State Health Plan                                9                   Chapter 7– Other Health Services
HOME HEALTH SERVICES
102 Home Health Care

   Mississippi licensure regulations define a home health agency as: a public or privately owned
   agency or organization, or a subdivision of such an agency or organization, properly authorized to
   conduct business in Mississippi, which is primarily engaged in providing to individuals at the
   written direction of a licensed physician, in the individual's place of residence, skilled nursing
   services provided by or under the supervision of a registered nurse licensed to practice in
   Mississippi, and one or more of the following additional services or items:

             1.   physical, occupational, or speech therapy

             2.   medical social services

             3.   home health aide services

             4.   other services as approved by the licensing agency

             5.   medical supplies, other than drugs and biologicals, and the use of medical
                  appliances

             6.   medical services provided by a resident in training at a hospital under a teaching
                  program of such hospital."

   All skilled nursing services and the services listed in items 1 through 4 must be provided directly
   by the licensed home health agency. For the purposes of this Plan, "directly" means either through
   an agency employee or by an arrangement with another individual not defined as a health care
   facility in Section 41-7-173 (h), Mississippi Code 1972, as amended. The requirements of this
   paragraph do not apply to health care facilities which had contracts for the above services with a
   home health agency on January 1, 1990.


   102.01    Home Health Status

      The latest Mississippi's 2008 Report on Home Health Agencies (the latest available) indicated
      that 76,318 Mississippians (non-duplicate count) received home health services during the
      year, a increase of 9.3 percent from the 69,825 patients served in 2007. There were 2,926,396
      home health care visits made in 2008. Each patient (all payor sources) received an average of
      38.34 visits. Mississippi has 11 hospital-based home health agencies, 39 freestanding agencies
      (including three Memphis agencies providing services in Mississippi), and 9 regional home
      health agencies operated by the MSDH.




2011 State Health Plan                              13                  Chapter 7– Other Health Services
2011 State Health Plan
  0




                                                                                                                  7-3
                                                                                                    Medicare Home Health Statistics
                                                                                                       in the Ten-State Region
                                                                                                  January 1, 2008– December 31, 2008
                                                                                                                                               Total
                                                                         2008 Total               Medicare-Paid                               Medicare
                                                               2010     Medicare-Paid              Home Health                                 Home       Average    Average
                                                             Population Home Health               Visits per 1,000    Total Medicare           Health  Reimbursement Visits per
                                                                65+        Visits                 Population 65+      Reimbursement           Patients   per Patient  Patient
                                        Region Total           9,575,245        43,158,654             4,507          $5,390,057,726           895,426           $6,020     48
                                        Alabama                  648,889         2,187,630             3,371           $319,082,183             63,915           $4,992     34
                                        Arkansas                 412,152         1,254,486             3,044           $148,406,330             32,884           $4,513     38
                                        Florida                3,418,697        22,833,938             6,679          $2,352,124,351           320,868           $7,331     71
    14




                                        Georgia                  980,824         2,508,112             2,557           $399,634,376             80,606           $4,958     31
                                        Kentucky                 557,471         1,649,298             2,959           $250,234,841             53,439           $4,683     31
                                        Louisiana                582,340         3,971,874             6,821           $523,854,084             73,241           $7,152     54
                                        Mississippi              379,025         1,996,937             5,269           $295,533,432             48,551           $6,087     41
                                        North Carolina         1,161,164         2,303,521             1,984           $400,943,138             95,905           $4,181     24
    Chapter 7 – Other Health Services




                                        South Carolina           605,660         1,147,818             1,895           $205,460,423             45,223           $4,543     25
                                        Tennessee                829,023         3,305,040             3,987           $494,784,568             80,794           $6,124     41

                                         Source: Palmetto GBA – Medicare Statistical Analysis Department, HCIS (Health Care Information System), June 29, 2010




                                        Chapter 7 – Other Health Services                    14                      2011 State Health Plan
                                                                             Figure 7-1
                                                     Total Medicare Paid Home Health Visits Per 1,000 Population
                                                                  Aged 65+ in the Ten-State Region
                                                                                2008
                                   8,000
                                                     6,821
                                                               6,679
                                   7,000

                                   6,000
                                                                                         5,269
     Visits per 1,000 Population




                                   5,000
                                                                                                   3,987
                                   4,000                                                                          3,371
                                                                                                                                         3,044         2,959
                                   3,000                                                                                                                            2,557
                                                                                                                                                                                       1,984                     1,895
                                   2,000

                                   1,000

                                       0
                                                     a              a               pi                            a                                                 ia                     a                     a
                                                 n             id                                 ee             m                  as                ky          rg                  in                    in
                                             sia            or                    ip            ss            ba                 ns            tu
                                                                                                                                                  c           o                    ol                    ol
                                        ui               Fl                    iss            ne          a                   ka            en             Ge                   ar
                                                                                                                                                                                                  Ca
                                                                                                                                                                                                     r
                                      Lo                                    iss             en         Al                  Ar                                                 C
                                                                        M                  T                                               K                             N.                    S.


   Note: 2008 Average Home Health Visits per 1,000 Population Aged 65+ in the Ten-State Region is 4,507.




2011 State Health Plan                                                                                                15                                   Chapter 7 – Other Health Services
103 Certificate of Need Criteria and Standards for Home Health Agencies/Services

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


   103.01    Policy Statement Regarding Certificate of Need Applications for the Establishment
             of a Home Health Agency and/or the Offering of Home Health Services

             1.   Service Areas: The need for home health agencies/services shall be determined on a
                  county by county basis.

             2.   Determination of Need: A possible need for home health services may exist in a
                  county if for the most recent calendar year available that county had fewer home
                  health care visits per 1,000 elderly (65+) population than the average number of
                  visits received per 1,000 elderly (65+) in the "ten-state region" consisting of
                  Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North
                  Carolina, South Carolina, and Tennessee. That number is currently 4,507, as shown
                  in Table 7-3 (CY 2008 is most recent data available).

             3.   Unmet Need: If it is determined that an unmet need exists in a given county, the
                  unmet need must be equivalent to 50 patients in each county proposed to be served.
                  Based on 2008 data 2,300 visits approximates 50 patients.

             4.   All CON applications for the establishment of a home health agency and/or the
                  offering of home health services shall be considered substantive and will be
                  reviewed accordingly.


   103.02    Certificate of Need Criteria and Standards for the Establishment of a Home Health
             Agency and/or the Offering of Home Heath Services

      If the present moratorium were removed or partially lifted, the MSDH would review
      applications for a CON for the establishment of a home health agency and/or the offering of
      home health services under the applicable statutory requirements of Sections 41-7-173,
      41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The MSDH will also review
      applications submitted for CON according to the general criteria as listed in the Mississippi
      Certificate of Need Review Manual; all adopted rules, procedures, and plans of the MSDH; and
      the specific criteria and standards listed below.

      The development or otherwise establishment of a home health agency requires CON. The
      offering of home health services is reviewable if the proposed provider has not provided those
      services on a regular basis within the period of twelve (12) months prior to the time such
      services would be offered.



Chapter 7 – Other Health Services                  16                    2011 State Health Plan
             1.     Need Criterion: The applicant shall document that a possible need for home
                    health services exists in each county proposed to be served using the
                    methodology contained in this section of the Plan.

             2.     The applicant shall state the boundaries of the proposed home health service area in
                    the application.

             3.     The applicant shall document that each county proposed to be served has an unmet
                    need equal to 50 patients, using a ratio of 2,300 patient visits equals 50 patients.

             4.     The applicant shall document that the home office of a new home health agency
                    shall be located in a county included in the approved service area of the new
                    agency. An existing agency receiving CON approval for the expansion of services
                    may establish a sub-unit or branch office if such meets all licensing requirements of
                    the Division of Licensure.

             5.     The application shall document the following for each county to be served:

                  a. Letters of intent from physicians who will utilize the proposed services.

                  b. Information indicating the types of cases physicians would refer to the proposed
                     agency and the projected number of cases by category expected to be served each
                     month for the initial year of operation.

                  c. Information from physicians who will utilize the proposed service indicating the
                     number and type of referrals to existing agencies over the previous 12 months.

                  d. Evidence that patients or providers in the area proposed to be served have
                     attempted to find services and have not been able to secure such services.

                  e. Projected operating statements for the first three years, including:

                       i.   total cost per licensed unit;

                      ii.   average cost per visit by category of visit; and

                     iii.   average cost per patient based on the average number of visits per patient.

             6.     Information concerning whether proposed agencies would provide services different
                    from those available from existing agencies.


   103.03    Statistical Need Methodology for Home Health Services

      The methodology used to calculate the average number of visits per 1,000 elderly (65+) in the
      10-state region is:

             1.     The 10-state region consists of Alabama, Arkansas, Florida, Georgia, Kentucky,
                    Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee.

             2.     The 2010 projected population aged 65 and older are estimates from each state.



2011 State Health Plan                                 17                 Chapter 7 – Other Health Services
             3.   Table 7-3 shows the average number of Medicare paid home health visits per 1,000
                  elderly (65+) for the 10-state region, according to 2008 data from Palmetto GBA -
                  Medicare Statistical Analysis Department of the Centers for Medicare and Medicaid
                  Services. Figure 7-1 shows the total number of Medicare paid home health visits per
                  1,000 elderly in the 10-state region.

             4.   In 2008, the region average of home health visits per 1,000 population aged 65 and
                  older was 4,507. An average patient in the region received 48 home health visits.
                  Therefore 2,300 visits equal 50 patients. Note: The Mississippi average for 2008
                  was 5,269 visits (Medicare reimbursed) per 1,000 population aged 65 and older, and
                  an average patient received 41 visits.




Chapter 7 – Other Health Services                  18                    2011 State Health Plan
END STAGE RENAL DISEASE SERVICES
104 End Stage Renal Disease

   End stage renal disease (ESRD) describes the loss of kidney function from chronic renal failure to
   the extent that the remaining kidney function will no longer sustain life. The kidney's function of
   filtering waste products from the blood and removing fluid and salts from the body is essential for
   life; consequently, if untreated, end stage renal disease results in death.

   Treatment generally consists of either transplantation or dialysis. Dialysis consists of either
   peritoneal dialysis or hemodialysis. In peritoneal dialysis, the patient's own abdominal membrane
   is part of the "equipment". A dialyzing fluid is placed in the abdominal cavity through a plastic
   tube, and waste products (fluid and salts) exchange across the peritoneal membrane between the
   patient's blood and the dialyzing fluid. Hemodialysis is the process by which an artificial kidney
   machine "washes" metabolic waste products from the bloodstream and removes fluids and salts.

   The kidney machine or peritoneal dialysis mimics the function normally done by the kidney.
   Dialysis can be done either by the patient and an assistant in the home, in a facility, or by
   professional staff in a hospital or limited care facility. Mississippi had 73 ESRD facilities
   providing maintenance dialysis services as of April 2009, and two additional facilities CON-
   approved but not yet operational (most recent data available). Map 7-1 shows the facility
   locations and Table 7-4 shows the number of existing and CON approved ESRD facilities by
   county.

   Kidney transplantation is the treatment of choice for most patients with end stage renal failure.
   Unfortunately, suitable kidneys will probably never be available in the number that would be
   required to treat everyone with this mode of therapy. In kidney transplantation, a healthy kidney is
   removed from a donor and placed into an ESRD patient. Donors for kidney transplantation may
   come either from a close relative, such as a sibling or parent, or from an emotionally connected
   donor, such as a spouse or close associate. Kidneys may also be obtained from cadaver donors
   who have the closest matching tissue type. Living donors are preferred because they function
   longer than cadaver kidneys – 30 years for a living donor versus 15 years for a cadaver kidney.

   The University of Mississippi Medical Center, the only kidney transplant program in the state,
   performed 76 cadaver and two living-donor transplants during the calendar year 2009. It is
   certified by membership in the United Network of Organ Sharing, a private agency under contract
   from the Health Care Financing Administration. Transplant results are comparable to those with
   transplant programs with similar population basis and can be viewed on the Internet under
   www.ustransplants.org. Approximately, 7 additional transplants in Mississippi residents are
   performed in neighboring states.




2011 State Health Plan                             21                  Chapter 7 – Other Health Services
                                          Table 7-4
               Number of Existing and CON Approved ESRD Facilities by County
                                                                       Number of Certified
                                                                       and CON Approved
                           ESRD Facilities by County                         Stations
            Adams                                                              31
            RCG of Natchez                                                     31
            Alcorn                                                                                          22
            RCG of Corinth                                                                                  22
            Attala                                                                                          15
            Central Dialysis Unit - Kosciusko                                                               15
            Bolivar                                                                                         29
            RCG of Cleveland                                                                                29
            Claiborne                                                                                         9
            Renex Dialysis Facility - Port Gibson                                                             9
            Clarke                                                                                            9
            Pachuta Dialysis Unit                                                                             9
            Coahoma                                                                                         34
            RCG of Clarksdale                                                                               34
            Copiah                                                                                          29
            Central Dialysis of Hazlehurst                                                                  12
            NRI of Hazlehurst                                                                               17
            Covington                                                                                       21
            Collins Dialysis Unit - Collins                                                                 21
            DeSoto                                                                                          40
            RCG of Southaven                                                                                40
            Forrest                                                                                         50
            Hattiesburg Clinic Dialysis Unit                                                                50
            Franklin                                                                                          4
            Magnolia Dialysis1- Meadville                                                                     4
            George                                                                                          12
            Lucedale Dialysis                                                                               12
            Grenada                                                                                         27
            RCG of Grenada                                                                                  27
            Hancock                                                                                         12
            South Miss Kidney Center - Diamondhead                                                          12


        Mississippi State Department of Health, Division of Health Facilities Licensure and Certification, April 2009
        1
            CON Approved but not yet licensed




Chapter 7 – Other Health Services                           22                         2011 State Health Plan
                                             Table 7-4 (Continued)
                   Number of Existing and CON Approved ESRD Facilities by County
                                                                      Number of Certified
                                                                      and CON Approved
                            ESRD Facilities by County                       Stations
          Harrison                                                            82
          South Mississippi Center of Biloxi                                  20
          South Miss Kidney Center - Gulfport                                 20
          South Miss Kidney Center - Orange Grove                             18
          South Miss Kidney Center - D'Iberville                               8
          South Miss Kidney Center - North Gulfport                           16
          Hinds                                                                             232
          Central Dialysis Unit                                                              37
          BMA of Southwest Jackson                                                           29
          NRI - Jackson North                                                                46
          NRI - Jackson South                                                                31
          NRI - Jackson Southwest                                                            18
          University Hospital and Clinics Outpatient Dialysis - Jackson                      36
          University Hospital & Clinics Transplantation                                      35
          Holmes                                                                             17
          NRI - Lexington                                                                    17
          Humphreys                                                                           6
          RCG of Belzoni                                                                      6
          Issaquena                                                                          12
          RCG of Mayersville                                                                 12
          Jackson                                                                            43
          Ocean Springs Dialysis                                                             17
          Pascagoula Dialysis                                                                26
          Jasper                                                                             21
          Bay Springs Dialysis Unit - Bay Springs                                            21
          Jefferson                                                                           8
          DRG Fayette                                                                         8
          Jones                                                                              34
          Laurel Dialysis Center - Laurel                                                    34
          Lafayette                                                                          27
          RCG Oxford                                                                         27
          Lauderdale                                                                         54
          RCG of Meridian                                                                    54
          Lawrence                                                                           15
          Silver Creek Dialysis                                                              15

          Leake                                                                              15
          NRI of Carthage                                                                    15
      1
          CON Approved but not yet licensed



2011 State Health Plan                              23                    Chapter 7 – Other Health Services
                                              Table 7-4 (continued)
                         Number of Existing and CON Approved ESRD Facilities by County
                                                                            Number of Certified
                                                                            and CON Approved
                              ESRD Facilities by County                           Stations
                Lee                                                                 34
                RCG of Tupelo                                                       34

                Leflore                                                                 27
                RCG of Greenwood                                                        27

                Lincoln                                                                 30
                RCG of Brookhaven                                                       30

                Lowndes                                                                 35
                RCG of Columbus                                                         35

                Madison                                                                 40
                Central Dialysis, Inc - Canton                                          18
                NRI of Canton                                                           22

                Marion                                                                  30
                Columbia Dialysis Unit - Columbia                                       30

                Marshall                                                                18
                RCG of Holly Springs                                                    18

                Monroe                                                                  30
                RCG of Aberdeen                                                         30

                Montgomery                                                               6
                RCG of Montgomery County                                                 6

                Neshoba                                                                 34
                RCG of Philadelphia                                                     34

                Newton                                                                  16
                RCG of Newton                                                           16

                Noxubee                                                                 14
                RCG of Macon                                                            14

                Oktibbeha                                                               21
                RCG of Starkville                                                       21

                Panola                                                                  24
                FMC of Sardis                                                           24

                Pearl River                                                             19
                Pearl River Dialysis Center - Picayune                                  19

            1
                CON Approved but not yet licensed




Chapter 7 – Other Health Services                        24         2011 State Health Plan
                                             Table 7-4 (continued)
                     Number of Existing and CON Approved ESRD Facilities by County
                                                                          Number of Certified
                                                                          and CON Approved
                               ESRD Facilities by County                       Stations
           Perry                                                                 17
           Richton Dialysis Unit                                                 17
           Pike                                                                     28
           RCG of McComb                                                            28
           Rankin                                                                   34
           FMC Dialysis Services of Rankin County-Brandon                           14
           NRI-Brandon                                                              20
           Scott                                                                    14
           Central Dialysis Unit of Forest                                          14
           Simpson                                                                  18
           Central Dialysis Unit of Magee                                           18
           Stone                                                                    12
           Wiggins Dialysis Unit                                                    12
           Sunflower                                                                21
           RCG of Indianola                                                         21
           Tallahatchie                                                              6
                                             1
           Healthcare Engineers - Charleston                                         6
           Tunica                                                                   12
           Tunica Dialysis                                                          12
           Walthall                                                                 21
           Tylertown Dialysis Unit                                                  21
           Warren                                                                   21
           RCG of Vicksburg                                                         21
           Washington                                                               42
           Mid-Delta Kidney Center, Inc                                              4
           RCG of Greenville                                                        38
           Wayne                                                                    15
           Waynesboro Renal Dialysis Unit                                           15
           Webster                                                                  14
           RCG of Europa                                                            14
           Wilkinson                                                                17
           RCG of Centerville                                                       17
           Winston                                                                  17
           RCG of Louisville                                                        17
           Yazoo                                                                    19
           Central Dialysis Unit - Yazoo City                                       19
           State Total                                                          1,616
       1
           CON Approved but not yet licensed



2011 State Health Plan                             25           Chapter 7 – Other Health Services
                                                Map 7-2
                                    End Stage Renal Disease Facilities




Chapter 7 – Other Health Services                    26                  2011 State Health Plan
104 Certificate of Need Criteria and Standards for End Stage Renal Disease Facilities

   Note: Should the Mississippi State Department of Health receive a Certificate of Need application
   regarding the acquisition and/or otherwise control of major medical equipment or the provision of
   a service for which specific CON criteria and standards have not been adopted, the application
   shall be deferred until the Department of Health has developed and adopted CON criteria and
   standards. If the Department has not developed CON criteria and standards within 180 days of
   receiving a CON application, the application will be reviewed using the general CON review
   criteria and standards presented in the Mississippi Certificate of Need Review Manual and all
   adopted rules, procedures, and plans of the Mississippi State Department of Health.


   104.01    Policy Statement Regarding Certificate of Need Applications for the Establishment
             of End Stage Renal Disease (ESRD) Facilities

             1.     Establishment of an ESRD Facility: The provision or proposed provision of
                    maintenance dialysis services constitutes the establishment of an ESRD facility if
                    the proposed provider has not provided those services on a regular basis within the
                    period of twelve (12) months prior to the time such services would be offered.

             2.     Annual Review Cycle: The MSDH shall accept and process CON applications
                    proposing the establishment of ESRD facilities in accordance with the following
                    review cycle:

                  a. Applications may be submitted only during the period beginning July 1 and ending
                     September 1 (5:00 p.m.) each year.

                  b. All applications received during this period (July 1 through September 1 each year)
                     which are deemed "complete" by October 1 of the year of submission, will be
                     entered into the 90-day review cycle (October-December cycle).

                  c. The State Health Officer will make CON decisions on "complete" applications in
                     the month of December each year.

                  d. Any CON application received other than in accordance with the above review
                     cycle shall not be accepted by the Department, but shall be returned to the
                     applicant.

             3.     Type of Review: CON applications for ESRD services shall be considered
                    substantive as defined under the appropriate Mississippi State Health Plan, and
                    "complete" competing applications from the same ESRD Facility Service Area shall
                    be batched.

             4.     ESRD Facility Service Area: An ESRD Facility Service Area is defined as the area
                    within a thirty (30) mile radius of an existing or proposed ESRD facility. ESRD
                    Facility Service Areas, including the Service Areas of existing facilities which
                    overlap with the proposed Service Area, shall be used for planning purposes.

             5.     CON Approval: A CON application for the establishment of an ESRD facility shall
                    be considered for approval only when each individual facility within an applicant's



2011 State Health Plan                               27                 Chapter 7 – Other Health Services
                    proposed ESRD Facility Service Area has maintained, at a minimum, an annual or
                    prorated utilization rate of 80 percent as verified by the MSDH. The 12 months
                    prior to the month of submission of the CON application shall be used to determine
                    utilization, if such information is available and verifiable by the Department.

             6.     Need Threshold: For planning and CON purposes a need for an additional ESRD
                    facility may exist when each individual operational ESRD station within a given
                    ESRD Facility Service Area has maintained an annual utilization rate of 80 percent,
                    i.e. an average of 749 dialyses per station per year.

             7.     Utilization Definitions:

                  a. Full Utilization: For planning and CON purposes, full (100 percent) utilization is
                     defined as an average of 936 dialyses per station per year.

                  b. Optimum Utilization: For planning and CON purposes, optimum (65 percent)
                     utilization is defined as an average of 608 dialyses per station per year.

                  c. Need Utilization: For planning and CON purposes, need (80 percent) utilization is
                     defined as an average of 749 dialyses per station per year.

          These utilization definitions are based upon three (3) shifts per day six (6) days per week,
          or eighteen (18) shifts per week. Only equipment (peritoneal or hemodialysis) that requires
          staff assistance for dialysis and is in operation shall be counted in determining the
          utilization rate. Utilization of equipment in operation less than twelve (12) months shall be
          prorated for the period of time in actual use.

             8.     Outstanding CONs: ESRD facilities that have received CON approval but are not
                    operational shall be considered to be operating at 50 percent, which is the minimum
                    utilization rate for a facility the first year of operation.

             9.     Utilization Data: The Department may use any source of data, subject to
                    verification by the Department, it deems appropriate to determine current utilization
                    or projected utilization of services in existing or proposed ESRD facilities. The
                    source of data may include, but is not limited to, Medicare Certification records
                    maintained by the Division of Health Facilities Licensure and Certification, ESRD
                    Network #8 data, and Centers for Medicare and Medicaid Services (CMS) data.

           10.      Minimum Expected Utilization: It is anticipated that a new ESRD facility may not
                    be able to reach optimum utilization (608 percent) of ten ESRD stations during the
                    initial phase of operation. Therefore, for the purposes of CON approval, an
                    application must demonstrate how the applicant can reasonably expect to have 50
                    percent utilization of a minimum of ten ESRD stations by the end of the first full
                    year of operation and 65 percent utilization by the end of the third full year of
                    operation.

           11.      Minimum Size Facility: No CON application for the establishment of a new ESRD
                    facility shall be approved for less than ten (10) stations.




Chapter 7 – Other Health Services                     28                           2011 State Health Plan
         12.     Expansion of Existing ESRD Facilities; Existing ESRD facilities may add ESRD
                 stations without certificate of need review, as long as the facility does not add, over a
                 period of two (2) years, more than the greater of four (4) stations or 15% of the
                 facility’s current number of certified stations.

         13.     Home Dialysis Programs: Each existing ESRD facility may establish or relocate one
                 home dialysis program to any location within a 5-mile radius of the existing facility
                 without certificate of need review; provided, however, that the facility shall submit an
                 application for determination of non-reviewability prior to the establishment of the
                 dialysis program. If such established or relocated home dialysis program is a
                 freestanding program, the freestanding home dialysis program shall document that it
                 has a back-up agreement for the provision of any necessary dialysis services with the
                 existing ESRD facility. If an existing ESRD facility wants to create, either through
                 establishment or relocation, more than one home dialysis program, the project shall be
                 subject to CON review as the establishment of a new ESRD facility.

         14.     Establishment of Satellite ESRD Facilities: Any existing ESRD facility which
                 reaches a total of 36 30 ESRD stations, may establish a ten (10) station satellite
                 facility. If a proposed satellite ESRD facility is to be located more than one (1) mile
                 from the existing facility, a certificate of need must be obtained by the facility prior to
                 the establishment of the satellite facility.

         15.     Non-Discrimination: An applicant shall affirm that within the scope of its available
                 services, neither the facility nor its staff shall have policies or procedures which would
                 exclude patients because of race, color, age, sex, or ethnicity.

         16.     Indigent/Charity Care: An applicant shall be required to provide a "reasonable
                 amount" of indigent/charity care as described in Chapter 1 of this Plan.

         17.     Staffing: The facility must meet, at a minimum, the requirements and qualifications
                 for staffing as contained in 42 CFR § 494.140. In addition, the facility must meet all
                 staffing requirements and qualifications contained in the service specific criteria and
                 standards.

         18.     Federal Definitions: The definitions contained in 42 CFR Subpart A § 494.10 shall be
                 used as necessary in conducting health planning and CON activities.

         19.     Affiliation with a Renal Transplant Center: ESRD facilities shall be required to enter
                 into a written affiliation agreement with a renal transplant center.


   104.02      Certificate of Need Criteria and Standards for End Stage Renal Disease (ESRD)
               Facilities

      The Mississippi State Department of Health will review applications for a Certificate of Need
      for the establishment of an ESRD facility under the applicable statutory requirements of
      Sections 41-7-173, 41-7-191, and 41-7-193, Mississippi Code of 1972, as amended. The
      MSDH will also review applications for Certificate of Need according to the general criteria as
      listed in the Mississippi Certificate of Need Review Manual; all adopted rules, procedures, and
      plans of the Mississippi State Department of Health; and the specific criteria and standards
      listed below.



2011 State Health Plan                                29                  Chapter 7 – Other Health Services
      When a provider proposes to offer ESRD services in an ESRD facility service area where he
      does not currently provide services or proposes to transfer an existing ESRD unit(s) from a
      current location into a different ESRD facility service area, it will constitute the establishment
      of a new ESRD health care facility. (Note: The transfer of dialysis stations from an existing
      ESRD facility to any other location is a relocation of a health care facility or portion thereof
      and requires Certificate of Need review. Likewise, new dialysis stations placed into service at a
      site separate and distinct from an existing ESRD facility constitutes the establishment of a new
      health care facility and requires Certificate of Need review. Dialysis stations placed into
      service in an individual patient's home or residence, solely for the treatment of the individual
      patient concerned, are exempt from this regulation.)


      104.02.01     Establishment of an End Stage Renal Disease (ESRD) Facility

             1.   Need Criterion for Establishment of New ESRD Facilities: An applicant
                  proposing the establishment of a limited care renal dialysis facility or the
                  relocation of a portion of an existing ESRD facility's dialysis stations to another
                  location shall demonstrate, subject to verification by the Mississippi State
                  Department of Health, that each individual existing ESRD facility in the
                  proposed ESRD Facility Service Area has maintained a minimum annual
                  utilization rate of eighty (80) percent.

             2.   Need Criterion for Expansion of Existing ESRD Facilities: In the event that an
                  existing ESRD facility proposes to add more than the greater of four (4) stations or
                  15% of the facility’s current number of certified stations within a two-year period,
                  then the facility must apply for a certificate of need, and shall document that it has
                  maintained a minimum annual utilization rate of 65% for the 12 months prior to the
                  month of the submission of the CON application. NOTE: ESRD Policy Statements
                  2, 4, 5 and 6, and Need Criterion 1, do not apply to applications for the expansion of
                  existing ESRD facilities.

             3.   Need Criterion for Establishment of ESRD Satellite Facilities: In order for a36 30
                  station ESRD facility to be approved for the establishment of a ten (10) station
                  satellite facility through the transfer and relocation of existing stations within a three
                  mile radius or less from the existing facility, the facility must (a) document that it
                  has maintained a minimum annual utilization rate of 65% for the 12 months prior to
                  the month of the submission of the CON application; (b) justify the need for the
                  project, which may include, but is not limited to, physical or space limitations at the
                  existing facility; and (c) document that it is more cost effective to establish a
                  satellite facility than to expand the existing facility. If the proposed satellite facility
                  will be established at a location between a three and twenty-five mile radius of the
                  existing facility, the facility must (a) document that it has maintained a minimum
                  annual utilization rate of 65% for the 12 months prior to the month of the
                  submission of the CON application; (b) justify the need for the project, which may
                  include, but is not limited to, physical or space limitations at the existing facility;
                  and (c) document that it is more cost effective to establish a satellite facility than to
                  expand the existing facility; and (d) demonstrate that the proposed satellite facility’s
                  location is not within thirty miles of an existing facility without obtaining the
                  existing facility’s written support. NOTE: ESRD Policy Statements 2, 4, 5 and 6,
                  and Need Criterion 1, do not apply to applications for the establishment of satellite
                  ESRD facilities. An ESRD satellite facility established under this Need Criterion 3



Chapter 7 – Other Health Services                     30                             2011 State Health Plan
                  shall not be used or considered for purposes of establishing or determining an ESRD
                  Facility Service Area.

          4.    Number of Stations: The applicant shall state the number of ESRD stations that are to
                be located in the proposed facility. No new facility shall be approved for less than ten
                (10) dialysis stations.

          5.    Minimum Utilization: The application shall demonstrate that the applicant can
                reasonably expect to meet the minimum utilization requirements as stated in ESRD
                Policy Statement #10.

          6.    Minimum Services: The application shall affirm that the facility will provide, at a
                minimum, social, dietetic, and rehabilitative services. Rehabilitative services may be
                provided on a referral basis.

          7.    Access to Needed Services: The application shall affirm that the applicant will
                provide for reasonable access to equipment/facilities for such needs as vascular access
                and transfusions required by stable maintenance ESRD patients.

          8.    Hours of Operation: The application shall state the facility's hours of operation each
                day of the week. The schedule should accommodate patients seeking services after
                normal working hours.

          9.    Home Training Program: The application shall affirm that the applicant will make a
                home training program available to those patients who are medically eligible and
                receptive to such a program. The application shall affirm that the applicant will
                counsel all patients on the availability of and eligibility requirements to enter the
                home/self-dialysis program.

         10.    Indigent/Charity Care: The application shall affirm that the applicant will provide a
                "reasonable amount" of indigent/charity care. The application shall also state the
                amount of indigent/charity care the applicant intends to provide.

         11.    Facility Staffing: The application shall describe the facility's staffing by category (i.e.,
                registered nurse, technologist, technician, social worker, dietician) as follows:

                a. Qualifications (minimum education and experience requirements)

                b. Specific Duties

                c. Full Time Equivalents (FTE) based upon expected utilization

         12.    Staffing Qualifications: The applicant shall affirm that the staff of the facility will
                meet, at a minimum, all requirements and qualifications as stated in 42 CFR, Subpart
                D § 494.140.

         13.    Staffing Time:

                a. The applicant shall affirm that when the unit is in operation, at least one (1) R.N.
                   will be on duty. There shall be a minimum of two (2) persons for each dialysis
                   shift, one of whom must be an R.N.



2011 State Health Plan                                31                  Chapter 7 – Other Health Services
                b. The applicant shall affirm that the medical director or a designated physician will
                   be on-site or on-call at all times when the unit is in operation. It is desirable to have
                   one other physician to supplement the services of the medical director.

                c. The applicant shall affirm that when the unit is not in operation, the medical
                   director or designated physician and a registered nurse will be on-call.

         14.    Data Collection: The application shall affirm that the applicant will record and
                maintain, at a minimum, the following utilization data and make this data available to
                the Mississippi State Department of Health as required. The time frame for the
                submission of the utilization data shall be established by the Department.

                a. Utilization data, e.g., days of operation, shifts, inventory and classification of all
                   stations, number of patients in dialysis, transplanted, or expired.

                b. The number of charity/indigent patients (as defined in this Plan) served by the
                   facility and the number of dialysis procedures provided to these patients free of
                   charge or at a specified reduced rate.

         15.    Staff Training: The application shall affirm that the applicant will provide an ongoing
                program of training in dialysis techniques for nurses and technicians at the facility.

         16.    Scope of Privileges: The applicant shall affirm that the facility shall provide access to
                doctors of medicine or osteopathic medicine licensed by the State of Mississippi who
                possess qualifications established by the governing body of the facility.

         17.    Affiliation with a Renal Transplant Center: The applicant shall affirm that within one
                year of commencing operation the facility will enter into an affiliation agreement with
                a transplantation center. The written agreement shall describe the relationship between
                the transplantation facility and the ESRD facility and the specific services that the
                transplantation center will provide to patients of the ESRD facility. The agreement
                must include at least the following:

                a. time frame for initial assessment and evaluation of patients for transplantation,

                b. composition of the assessment/evaluation team at the transplant center,

                c. method for periodic re-evaluation,

                d. criteria by which a patient will be evaluated and periodically re-evaluated for
                   transplantation, and

                e. signatures of the duly authorized persons representing the facilities and the agency
                   providing the services.

                f. Furthermore, the application shall affirm that the applicant understands and agrees
                   that failure to comply with this criterion may (after due process) result in
                   revocation of the Certificate of Need.




Chapter 7 – Other Health Services                     32                             2011 State Health Plan
      104.02.02       Establishment of a Renal Transplant Center

             1.     Need Criterion: The applicant shall document that the proposed renal
                    transplant center will serve a minimum population of 3.5 million people.

             2.     The applicant shall document that the proposed facility will provide, at a minimum,
                    the following:

                  a. medical-surgical specialty services required for the care of ESRD transplant
                     patients;

                  b. acute dialysis services;

                  c. an organ procurement system;

                  d. an organ preservation program; and

                  e. a tissue typing laboratory.

             3.     The applicant shall document that the facility will perform a minimum of 25
                    transplants annually.




2011 State Health Plan                               33                 Chapter 7 – Other Health Services
GLOSSARY
.
Glossary
Accessibility — a measure of the degree to which the health care delivery system inhibits or
facilitates an individual's ability to receive its services, including geographic, architectural,
transportation, social, time, and financial considerations.

Ambulatory Surgery — surgical procedures that are more complex than office procedures
performed under local anesthesia but less complex than major procedures requiring prolonged
post-operative monitoring and hospital care to ensure safe recovery and desirable results. General
anesthesia is used in most cases. The patient must arrive at the facility and expect to be discharged on
the same day. Ambulatory surgery shall be performed only by physicians or dentists licensed to
practice in the state of Mississippi.

Examples of procedures performed include, but are not limited to:

        Tonsillectomies and adenoidectomies
        Nasal polypectomy
        Submucosa resection
        Some cataract procedures
        Cosmetic procedures
        Breast biopsy
        Augmentation mammoplasty
        Hand surgery
        Cervical conization
        Laparoscopy and tubal sterilization
        Circumcision
        Urethral dilation
        Simple hernia repairs
        Stripping and ligation of varicose veins

Ambulatory Surgical Facility — a publicly or privately owned institution which is primarily
organized, constructed, renovated, or otherwise established for the purpose of providing elective
surgical treatment of outpatients whose recovery, under normal and routine circumstances, will not
require inpatient care. Such facility as herein defined does not include the offices of private
physicians or dentists whether practicing individually or in groups, but does include organizations or
facilities primarily engaged in such outpatient surgery, whether using the name "ambulatory surgical
facility" or a similar or different name. Such organization or facility, if in any manner considered to
be operated or owned by a hospital or a hospital holding, leasing, or management company, either
for-profit or not-for-profit, is required to comply with all Mississippi State Department of Health
ambulatory surgical licensure standards governing a hospital affiliated facility as adopted under
Section 41-9-1 et seq., Mississippi Code of 1972, provided that such organization or facility does not
intend to seek federal certification as an ambulatory surgical facility as provided for 42 CFR, Parts
405 and 416. Further, if such organization or facility is to be operated or owned by a hospital or a
hospital holding, leasing, or management company and intends to seek federal certification as an


2011 State Health Plan                                1                                             Glossary
ambulatory facility, then such facility is considered to be freestanding and must comply with all
Mississippi State Department of Health ambulatory surgical licensure standards governing a
freestanding facility. If such organization or facility is to be owned or operated by an entity or person
other than a hospital or hospital holding, leasing, or management company, then such organization or
facility must comply with all Mississippi Department of Health ambulatory surgical facility standards
governing a freestanding facility.

Bed Need Methodologies — quantitative approaches to determining present and future needs for
inpatient beds.

Capital Improvements — costs other than construction which will yield benefits over a period of
years. Examples of capital improvements are painting, refurbishing, and land improvements, such as
improving driveways, fences, parking lots, and sprinkler systems.

Capitalized Interest — interest incurred during the construction period, which is included in debt
borrowing.

Construction Formulas —

      New Construction/Renovation
      (Prorated Project):      Cost/square foot = A+C+D+(E+F+G(A%*))
                                                  New Const. Square Feet

                                      Cost/square foot = B+(E+F+G(B%))**+H
                                                         Renov. Square Feet

      New Construction
      (No Renovation Involved):       Cost/square foot = A+C+D+E+F+G
                                                         Square Feet

      Renovation
      (No New Construction):          Cost/square foot = B+C+E+F+G+H
                                                         Square Feet

           When:    A = New Construction          E = Fees
                    B = Renovation                F = Contingency
                    C = Fixed Equipment           G = Capitalized Interest
                    D = Site Preparation          H = Capital Improvement

*A% - refers to the percentage of square feet allocated to new construction.

**B% - refers to the percentage of square feet allocated to renovation.

Example:       ABC Health Care's project for construction/renovation consists of 10,000 square feet of
               new construction and 9,000 square feet of renovation, for a total of 19,000 square feet.

A%         =       10,000 or 53%
                   19,000

B%         =        9,000 or 47%
                   19,000



Glossary                                             2                             2011 State Health Plan
Continuing Care Retirement Community — a comprehensive, cohesive living arrangement for the
elderly which is offered under a contract that lasts for more than one year or for the life of the resident
and describes the service obligations of the CCRC and the financial obligations of the resident. The
contract must obligate the CCRC to provide, at a minimum, room, board, and nursing care to an
individual not related by consanguinity or affinity to the provider furnishing such care. The contract
explicitly provides for full lifetime nursing home care as required by the resident. The resident may
be responsible for the payment of some portion of the costs of his/her nursing home care, and the
CCRC sponsor is responsible for the remaining costs as expressly set forth in the contract. Depletion
of the contractee's personal resources does not affect the contribution of the CCRC sponsor.

Conversion — describes a major or proportional change that a health care facility undertakes in its
overall mission, such as the change from one licensure category to another, from one organizational
tax status to another, or from one type of health care facility to another.

Cost Containment — the control of the overall costs of health care services within the health care
delivery system.

Criteria — guidelines or pre-determined measurement characteristics on which judgment or
comparison of need, appropriateness, or quality of health services may be made.

Distinct Part Skilled Nursing Unit - Medicare eligible certified units which meet the current
definition of “Distinct Part of an Institution as SNF” as defined in the current Medicare Part A
Intermediary Manual by the Centers for Medicare and Medicaid Services (CMS) of the U.S.
Department of Health and Human Services.

Existing Provider — an entity that has provided a service on a regular basis during the most recent
12-month period.

Facilities — collectively, all buildings constructed for the purpose of providing health care (including
hospitals, nursing homes, clinics, or health centers, but not including physician offices); encompasses
physical plant, equipment, and supplies used in providing health services.

Feasibility Study — a report prepared by the chief financial officer, CPA or an independent
recognized firm of accountants demonstrating that the cash flow generated from the operation of the
facility will be sufficient to complete the project being financed and to pay future annual debt service.
The study includes the financial analyst's opinion of the ability of the facility to undertake the debt
obligation and the probable effect of the expenditure on present and future operating costs.

Freestanding Ambulatory Surgical Facility — a separate and distinct facility or a separate and
distinct organized unit of a hospital owned, leased, rented, or utilized by a hospital or other persons
for the primary purpose of performing ambulatory surgery procedures. Such facility must be
separately licensed as herein defined and must comply with all licensing standards promulgated by
the Mississippi State Department of Health regarding a freestanding ambulatory surgical facility.
Further, such facility must be a separate, identifiable entity and must be physically, administratively,
and financially independent and distinct from other operations of any other health facility and shall
maintain a separate organized medical and administrative staff. Furthermore, once licensed as a
freestanding ambulatory surgical facility, such facility shall not become a component of any other
health facility without securing a Certificate of Need to do so.




2011 State Health Plan                                3                                          Glossary
Group Home — a single dwelling unit whose primary function is to provide a homelike residential
setting for a group of individuals, generally 8 to 20 persons, who neither live in their own home nor
require institutionalization. Group homes are used as a vehicle for normalization.

Habilitation — the combined and coordinated use of medical, social, educational, and vocational
measures for training individuals who are born with limited functional ability as contrasted with
people who have lost abilities because of disease or injury.

Home Health Agency — certain services must be provided directly by a licensed home health
agency and must include all skilled nursing services; physical, occupational, or speech therapy;
medical social services; part-time or intermittent services of a home health aide; and other services as
approved by the licensing agency for home health agencies. In this instance, "directly" means either
through an agency employee or by an arrangement with another individual not defined as a health
care facility.

Hospital Affiliated Ambulatory Surgical Facility — a separate and distinct organized unit of a
hospital or a building owned, leased, rented, or utilized by a hospital and located in the same county
in which the hospital is located for the primary purpose of performing ambulatory surgery procedures.
Such facility is not required to be separately licensed and may operate under the hospital's license in
compliance with all applicable requirements of Section 41-9-1 et seq.

Limited Care Renal Dialysis Facility — a health care facility which provides maintenance or
chronic dialysis services on an ambulatory basis for stable ESRD patients. The limited care renal
dialysis facility is considered a substitute for home dialysis to be used by patients who cannot dialyze
at home. The facility provides follow-up and back-up services for home dialysis patients.

Magnetic Resonance Imaging (MRI) Scientist — a professional with similar skills and job
qualifications as a medical physicist, who holds a comparable degree in an allied science, such as
chemistry or engineering, and shows similar experience as the medical physicist with medical
imaging and MRI imaging spectroscopy.

Market Share — historical data used to define a primary or secondary geographic service area, i.e.
patient origin study, using counties, zip codes, census tracts.

Observation Bed — a licensed, acute care bed on the premise of a licensed, short-term, acute care
facility. The hospital bed shall be used by a physician and/or nursing/medical staff to periodically
monitor/evaluate a patient’s medical condition. A bed that is occupied by a patient who is admitted to
the hospital for a period of 23 hours and 59 minutes or ≤ (less than) 48 hours will be counted as an
observation bed. Also, the status of a patient will be documented by a physician as an outpatient.

Observation Services — a well-defined set of specific, clinically appropriate services, which include
ongoing short term treatment, assessment, and reassessment, that are furnished while a decision is
being made regarding whether patients will require further treatment as hospital inpatients or if they
are able to be discharged from the hospital. Observation services begin at the clock time documented
in the patient’s medical record, which coincides with the time that observation services are initiated in
accordance with a physician’s order for observation services. In most cases, a beneficiary (patient)
may not remain in observation status for more than 24 or 48 hours. The hospital status of a patient
will be documented as an outpatient until the physician writes an order to admit a person as an
inpatient. Billing and coding of physician services are expected to be billed consistent with the
patient’s status as an outpatient or an inpatient.




Glossary                                             4                            2011 State Health Plan
General standing orders for observation services following all outpatient surgery are not recognized.
Hospitals should not report postoperative monitoring during a standard recovery period (e.g., 4-6
hours) as observation care, services because those hours may be considered recovery room services.

Occupancy Rate — measure of average percentage of hospital beds occupied; determined by
dividing available bed-days (bed capacity) by patient days actually used during a specified time
period.
Outpatient Facility — a medical institution designed to provide a limited or full spectrum of health
and medical services (including health education and maintenance services, preventive services,
diagnosis, treatment, and rehabilitation) to individuals who do not require hospitalization or
institutionalization.

Pediatric Skilled Nursing Facility — a pediatric skilled nursing facility is an institution or a distinct
part of an institution that is primarily engaged in providing to inpatients skilled nursing care and
related services for persons under 21 years of age who require medical, nursing care, or rehabilitation
services for the rehabilitation of injured, disabled, or sick persons.

Policy Statement — a definite course of action selected in light of given conditions to guide and
determine present and future decisions.

Positron Emission Tomography (PET) — a non-invasive imaging procedure in which positron-
emitting radionuclides, that are produced either by a cyclotron or a radiopharmaceutical producing
generator, and a nuclear camera are used to create pictures of organ function rather than structure.
PET, therefore, has the potential for providing unique, clinically important information about disease
processes. Key applications for PET are in coronary artery disease and myocardial infarction,
epilepsy, cerebral gliomas, and dementia.

Radiation Therapy — the use of ionizing radiations for the treatment of tumors.

Renal Dialysis Center — a health care facility which provides dialysis services to hospital patients
who require such services. The dialysis provided in a renal dialysis center functions primarily as a
backup program for ESRD patients dialyzing at home or in a limited care facility who are placed in a
hospital. A renal dialysis center may also serve as an initial dialysis setting for newly diagnosed
ESRD patients who are in the hospital. A center may also provide acute dialysis services as needed.

Renal Transplant Center — a health care facility which provides direct transplant and other
medical-surgical specialty services required for the care of the ESRD transplant patient. Services
provided include, but are not limited to, acute renal dialysis, organ procurement system, organ
preservation program, and tissue typing laboratory.

Standard — a quantitative level to be achieved regarding a particular criterion to represent
acceptable performance as judged by the agency establishing the standard.

Therapeutic Radiation Services — therapeutic radiation treatments/procedures delivered through
the use of a linear accelerator or 60Co teletherapy unit.

Therapeutic Radiation Unit/Equipment — a linear accelerator or 60Co teletherapy unit. This
equipment is also commonly referred to as a "megavoltage therapeutic radiation unit/equipment."




2011 State Health Plan                               5                                          Glossary
.
     APPENDIX
NURSING HOME BED NEED
       2020
                                                                                                           Table 2-3A
2011 State Health Plan




                                                                                             2020 Projected Nursing Home Bed Need1
                                                                                                    State of Mississippi
                                        Long-Term                                                                                                        Total
                                       Care Planning Population Bed Need Population Bed Need Population Bed Need Population Bed Need                     Bed   Beds in Licensed/CON
                                          District     0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84 (36/1,000)        85+ (135/1,000)                 Need Abeyance Approved Beds Difference

                                   District I             466,409         233       51,598        516     31,668       1,140      18,130         2,448    4,337        130   3,239 / 60            908
                                   District II            485,264         243       58,086        581     39,333       1,416      23,451         3,166    5,405         28   4,106 0             1,271
                                   District III           601,285         301       81,080        811     45,992       1,656      27,683         3,737    6,504         57   4,644 0             1,803
                                   District IV            867,359         434      102,142      1,021     65,777       2,368      38,630         5,215    9,038        310   5,392 / 240         3,096

                                   State Total          2,420,317       1,210      292,906      2,929    182,770       6,580     107,894        14,566   25,285        525 17,381 / 300          7,079

                                   1
                                       Data may not equal totals due to rounding


                                       Note: Licensed beds do not include 694 beds operated by the Department of Mental Health, 120 beds operated by the Mississippi Band of Choctaw Indians, 600
                                       beds operated by the Mississippi Veteran’s Affairs Board, 60 beds operated by the Mississippi Methodist Rehabilitation Center for the treatment of patients with
1




                                       special disabilities, including persons with spinal cord and closed-head injuries and ventilator-dependent patients, or 284 beds licensed to continuing care
                                       retirement communities (CCRC).

                                       Sources: Mississippi State Department of Health, Division of Licensure and Certification; and Division of Health Planning and Resource Development
                                       Calculations, 2010
Appendix – Nursing Home Bed Need




                                       Population Projections: Mississippi Population Projections 2010, 2015, and 2020. Center for Policy Research and Planning, Mississippi Institutions of Higher
                                       Learning, August 2005
                                                                                                                 Table 2-3A (continued)
                   2011 State Health Plan
– Long-Term Care




                                                                                                         2020 Projected Nursing Home Bed Need

                                                                                                                           District I

                                                                      Population Bed Need Population Bed Need Population   Bed Need      Population Bed Need       Total Bed # Beds in Licensed/CON
                                                          County        0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84    (36/1,000)       85+     (135/1,000)      Need    Abeyance Approved Beds Difference

                                                     Attala              15,458       7.73     1,952     19.52     1,557         56.05          983       132.71        216         0     120               96
                                                     Bolivar             30,440      15.22     3,432     34.32     2,004         72.14        1,141       154.04        276        60     350   0         -134
                                                     Carroll              8,212       4.11     1,229     12.29       847         30.49          465        62.78        110         0      60   0           50
                                                     Coahoma             23,266      11.63     2,568     25.68     1,620         58.32        1,013       136.76        232         8     178   0           46

                                                     DeSoto             148,570      74.29    14,607    146.07     8,005       288.18         3,986       538.11       1,047        0     320   0          727
                                                     Grenada             18,716       9.36     2,325     23.25     1,609        57.92           984       132.84         223        0     257   0          -34
                                                     Holmes               6,220       3.11     1,640     16.40     1,100        39.60           696        93.96         153        0     148   0            5
                                                     Humphreys           10,148       5.07       982      9.82       594        21.38           379        51.17          87        0      60   0           27

                                                     Leflore             28,785      14.39     2,788     27.88     1,763         63.47        1,060       143.10        249         0     410   0         -161
                                                     Montgomery           8,553       4.28     1,204     12.04       930         33.48          585        78.98        129         0     120   0            9
                   2




                                                     Panola              31,479      15.74     3,494     34.94     2,234         80.42        1,316       177.66        309         0     190              119
                                                     Quitman              9,049       4.52       860      8.60       616         22.18          385        51.98         87         0      60   0           27

                                                     Sunflower           28,949      14.47     2,462     24.62     1,416         50.98         825        111.38        201         2     242 0            -43
                                                     Tallahatchie        10,991       5.50     1,368     13.68       953         34.31         577         77.90        131         0      68 / 60           3
                                                     Tate                24,552      12.28     2,832     28.32     1,773         63.83         992        133.92        238         0     120 0            118
                                                     Tunica               9,359       4.68     1,032     10.32       556         20.02         290         39.15         74         0      60 0             14
                   Appendix– Nursing Home Bed Need




                                                     Washington          43,587      21.79     5,454     54.54     3,092       111.31         1,839       248.27        436        58     356               22
                                                     Yalobusha           10,075       5.04     1,369     13.69       999        35.96           614        82.89        138         2     120               16

                                                     District Total     466,409     233.20    51,598    515.98    31,668      1,140.05       18,130     2,447.55       4,337      130    3,239 / 60        908
                                                                                             Table 2-3A (continued)
                                                                                     2020 Projected Nursing Home Bed Need
2011 State Health Plan




                                                                                                         District II

                                                    Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed # Beds in Licensed/CON
                                      County          0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84 (36/1,000)   85+     (135/1,000) Need   Abeyance Approved Beds Difference

                                   Alcorn               26,843     13.42     3,849     38.49     2,865       103.14     1,664    224.64     380       0     264    0        116
                                   Benton                5,638      2.82       722      7.22       562        20.23       360     48.60      79       0      60    0         19
                                   Calhoun               9,606      4.80     1,486     14.86     1,149        41.36       721     97.34     158       0     155    0          3
                                   Chickasaw            13,413      6.71     1,743     17.43     1,223        44.03       750    101.25     169       0     139    0         30
                                                             0
                                   Choctaw               7,701      3.85     1,075     10.75       731        26.32       450     60.75     102      13      73    0         16
                                   Clay                 16,796      8.40     2,150     21.50     1,289        46.40       818    110.43     187       0     180    0          7
                                   Itawamba             20,645     10.32     2,490     24.90     1,884        67.82     1,095    147.83     251       0     196    0         55
                                   Lafayette            40,009     20.00     3,460     34.60     2,222        79.99     1,323    178.61     313       0     180    0        133

                                   Lee                  63,513     31.76     7,930     79.30     4,921       177.16     2,856    385.56     674       0     487    0        187
                                   Lowndes              46,855     23.43     5,686     56.86     3,503       126.11     2,042    275.67     482       0     380    0        102
                                   Marshall             31,476     15.74     3,590     35.90     2,278        82.01     1,236    166.86     301       0     180             121
                                   Monroe               29,904     14.95     3,887     38.87     2,763        99.47     1,678    226.53     380       0     332    0         48
3




                                   Noxubee               8,959      4.48     1,087     10.87       652        23.47       396     53.46      92       0      60    0         32
                                   Oktibbeha            39,261     19.63     3,349     33.49     2,062        74.23     1,172    158.22     286       0     179    0        107
                                   Pontotoc             25,434     12.72     2,965     29.65     1,892        68.11     1,144    154.44     265       0     164    0        101
                                   Prentiss             22,393     11.20     2,650     26.50     1,971        70.96     1,168    157.68     266       0     144    0        122
Appendix – Nursing Home Bed Need




                                   Tippah               17,387      8.69     2,143     21.43     1,598        57.53       977    131.90     220       0     240    0        -20
                                   Tishomingo           14,088      7.04     2,098     20.98     1,707        61.45     1,047    141.35     231      15     178    0         38
                                   Union                22,731     11.37     2,722     27.22     1,894        68.18     1,170    157.95     265       0     180              85
                                   Webster               7,337      3.67       966      9.66       758        27.29       487     65.75     106       0     155    0        -49

                                   Winston              15,275      7.64     2,038     20.38     1,409        50.72       897     121.10     200      0      180   0         20
                                   District Total      485,264    242.63    58,086    580.86    39,333     1,415.99    23,451   3,165.89   5,405     28    4,106   0      1,271
State Health Plan




                                                                                            Table 2-3A (continued)
                                                                                     2020 Projected Nursing Home Bed Need
      2011 State Health Plan




                                                                                                        District III

                                                    Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed # Beds in Licensed/CON
                                       County         0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84  (36/1,000)  85+     (135/1,000) Need   Abeyance Approved Beds Difference

                                   Adams                20,709     10.35    3,577     35.77     2,300        82.80      1,664    224.64     354      20      254    0        80
                                   Amite                10,213      5.11    1,457     14.57     1,056        38.02        617     83.30     141       0       80    0        61
                                   Claiborne            10,792      5.40      995      9.95       548        19.73        354     47.79      83       0       77    0         6
                                   Copiah               25,875     12.94    3,921     39.21     1,842        66.31      1,101    148.64     267       0      180    0        87

                                   Franklin              6,671      3.34      888      8.88       611        22.00        393      53.06      87      0        60   0        27
                                   Hinds               191,559     95.78   22,268    222.68    12,594       453.38      7,489   1,011.02   1,783      6     1,427   0       350
                                   Issaquena             2,196      1.10      184      1.84       143         5.15         83      11.21      19      0         0   0        19
                                   Jefferson             7,688      3.84      820      8.20       493        17.75        308      41.58      71      0        60   0        11
6




                                   Lawrence             11,437      5.72    1,406     14.06       951        34.24        591     79.79     134       0       60    0        74
                                   Lincoln              28,787     14.39    3,651     36.51     2,420        87.12      1,467    198.05     336      0       320    0        16
                4




                                   Madison               6,841      3.42    8,840     88.40     3,427       123.37      2,464    332.64     548      0       395    0       153
                                   Pike                 33,699     16.85    4,103     41.03     2,627        94.57      1,642    221.67     374       0      285    0        89

                                   Rankin              133,958     66.98   15,364    153.64     8,366       301.18      4,380    591.30    1,113      0      350    0       763
                                   Sharkey               4,243      2.12      622      6.22       327        11.77        197     26.60       47      0       54    0        -7
Appendix – Nursing Home Bed Need
 Chapter 8 – Long-Term Care




                                   Simpson              23,998     12.00    2,913     29.13     1,905        68.58      1,149    155.12      265      0      180    0        85
                                   Walthall             11,877      5.94    1,499     14.99     1,064        38.30        639     86.27      145      0      137    0         8

                                   Warren               36,895     18.45    5,132     51.32     3,022       108.79      1,723    232.61     411      31      380    0         0
                                   Wilkinson             8,346      4.17      958      9.58       633        22.79        401     54.14      91       0      105    0       -14
                                   Yazoo                25,501     12.75    2,482     24.82     1,663        59.87      1,021    137.84     235       0      240    0        -5

                                   District Total     601,285     300.64   81,080    810.80    45,992      1,655.71    27,683   3,737.21   6,504     57     4,644   0     1,803
                                                                                               Table 2-3A (continued)
                                                                                       2020 Projected Nursing Home Bed Need
2011 State Health Plan




                                                                                                     District IV
                                                                                                                                                           Licensed/CON
                                                    Population Bed Need Population Bed Need Population Bed Need Population Bed Need Total Bed # Beds in      Approved
                                       County         0 - 64   (0.5/1,000) 65 - 74 (10/1,000) 75 - 84   (36/1,000) 85+     (135/1,000) Need   Abeyance          Beds    Difference
                                   Clarke               12,807        6.40     1,796    17.96     1,270      45.72     787      106.25    176          0      120 0             56
                                   Covington            17,741        8.87     1,912    19.12     1,392      50.11     821      110.84    189          0       60 / 60          69
                                   Forrest              69,801       34.90     6,515    65.15     4,304     154.94   2,548      343.98    599         93      486 0             20
                                   George               19,637        9.82     2,089    20.89     1,389      50.00     744      100.44    181          0       60 / 60          61

                                   Greene              14,770       7.39     1,289     12.89       845     30.42       465      62.78      113         0     120   0           -7
                                   Hancock             42,171      21.09     5,971     59.71     3,961    142.60     2,191     295.79      519        29     169              321
                                   Harrison           167,267      83.63    19,128    191.28    11,720    421.92     6,799     917.87    1,615       120     796              699
                                   Jackson            120,471      60.24    14,609    146.09     8,761    315.40     4,774     644.49    1,166         0     528   0          638

                                   Jasper              15,681       7.84     1,806     18.06     1,236     44.50       763     103.01     173          0     110   0           63
                                   Jeff Davis          10,580       5.29     1,377     13.77       959     34.52       573      77.36     131          0      60   0           71
                                   Jones               53,759      26.88     6,747     67.47     4,627    166.57     2,869     387.32     648         10     428   0          210
                                   Kemper               9,186       4.59     1,035     10.35       718     25.85       461      62.24     103                 60   0           43

                                   Lamar               43,984      21.99     4,631     46.31     2,608     93.89     1,450     195.75     358          3     150              205
5




                                   Lauderdale          61,800      30.90     7,660     76.60     5,185    186.66     3,266     440.91     735         52     540   0          143
                                   Leake               18,024       9.01     2,220     22.20     1,500     54.00       931     125.69     211          0     143   0           68
                                   Marion              20,164      10.08     2,583     25.83     1,690     60.84     1,072     144.72     241          0     297   0          -56

                                   Neshoba             25,768      12.88     3,002     30.02     2,045     73.62     1,273     171.86     288          3     220               65
Appendix – Nursing Home Bed Need




                                   Newton              18,049       9.02     2,186     21.86     1,559     56.12       988     133.38     220          0     180               40
                                   Pearl River         47,358      23.68     6,188     61.88     4,049    145.76     2,239     302.27     534          0     246 / 120        168
                                   Perry               11,129       5.56     1,296     12.96       847     30.49       476      64.26     113          0      60 0             53

                                   Scott               23,951      11.98     2,820     28.20     1,789     64.40     1,088     146.88     251          0     140   0          111
                                   Smith               11,788       5.89     1,602     16.02     1,183     42.59       707      95.45     160          0     121   0           39
                                   Stone               13,689       6.84     1,632     16.32     1,002     36.07       549      74.12     117          0     208   0          -91
                                   Wayne               17,784       8.89     2,048     20.48     1,138     40.97       796     107.46     178          0      90   0           88

                                   District Total     867,359     433.68   102,142   1,021.42   65,777   2,367.97   38,630   5,215.05    9,038       310 5,392 / 240         3,096